| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $115.59 | $137.51 | $137.51 | |
Aetna
| Professional | $115.59 | $142.10 | $170.86 | |
Martin's Point
| Facility | $137.51 | $137.51 | $137.51 | |
Martin's Point
| Professional | $115.59 | $141.80 | $170.86 | |
United
| Professional | $154.77 | $194.41 | $305.57 |