| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | AA | $702.75 | $702.75 | $702.75 |
Aetna
| Facility | QX | $315.72 | $525.41 | $861.05 |
Martin's Point
| Facility | AA | $702.75 | $702.75 | $702.75 |
Martin's Point
| Facility | QX | $228.21 | $315.72 | $861.05 |