| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $194.98 | $562.34 | $776.25 | |
Aetna
| Professional | $138.04 | $190.55 | $239.88 | |
Martin's Point
| Facility | $194.98 | $562.34 | $776.25 | |
Martin's Point
| Professional | $128.82 | $181.97 | $251.19 | |
United
| Facility | $0.19 | $0.19 | $0.19 | |
United
| Professional | $173.78 | $229.09 | $389.05 |