| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | AA | $448.20 | $448.20 | $960.30 |
Aetna
| Facility | QK | $276.26 | $276.26 | $276.26 |
Aetna
| Facility | QX | $407.68 | $418.40 | $666.03 |
Martin's Point
| Facility | AA | $448.20 | $448.20 | $960.30 |
Martin's Point
| Facility | QK | $276.26 | $276.26 | $276.26 |
Martin's Point
| Facility | QX | $152.13 | $407.68 | $666.03 |