| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $188.41 | $367.86 | $641.84 | |
Aetna
| Facility | 53 | $94.06 | $94.06 | $216.28 |
Cigna
| Facility | $263.52 | $263.52 | $456.00 | |
Cigna
| Facility | 53 | $52.70 | $52.70 | $52.70 |
Martin's Point
| Facility | $641.84 | $641.84 | $641.84 |