| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | QX | $1,071.52 | $1,071.52 | $10,964.78 |
Wellcare
| Facility | QK | $52.48 | $52.48 | $52.48 |
Wellcare
| Facility | QX | $52.48 | $52.48 | $52.48 |
Wellcare
| Facility | QY | $52.48 | $52.48 | $52.48 |