| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | AA | $2,398.83 | $2,818.38 | $4,466.84 |
Martin's Point
| Professional | AA | $2,398.83 | $2,818.38 | $4,466.84 |
Martin's Point
| Professional | QZ | $302.00 | $302.00 | $302.00 |