| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | AA | $1,230.27 | $1,230.27 | $1,230.27 |
Aetna
| Facility | QX | $575.44 | $575.44 | $575.44 |
Martin's Point
| Facility | AA | $1,230.27 | $1,230.27 | $1,230.27 |
Martin's Point
| Facility | QX | $575.44 | $575.44 | $575.44 |