| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $190.55 | $190.55 | $208.93 | |
Aetna
| Facility | 54 | $141.25 | $141.25 | $141.25 |
Martin's Point
| Facility | $190.55 | $190.55 | $208.93 | |
Martin's Point
| Facility | 54 | $141.25 | $141.25 | $141.25 |