| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $19.57 | $99.98 | $701.93 | |
Aetna
| Facility | 25 | $125.10 | $125.10 | $125.10 |
Cigna
| Facility | $464.22 | $464.22 | $464.22 | |
Martin's Point
| Facility | $84.77 | $84.77 | $138.55 | |
Martin's Point
| Facility | 25 | $125.10 | $125.10 | $125.10 |