| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | QK | $371.54 | $371.54 | $371.54 |
Aetna
| Facility | QX | $162.18 | $162.18 | $186.21 |
Aetna
| Professional | AA | $616.60 | $1,412.54 | $4,265.80 |
Martin's Point
| Facility | QK | $371.54 | $371.54 | $371.54 |
Martin's Point
| Facility | QX | $162.18 | $162.18 | $186.21 |
Martin's Point
| Professional | AA | $416.87 | $707.95 | $3,801.89 |