| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | QX | $912.01 | $912.01 | $6,309.57 |
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 |