| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $190.55 | $190.55 | $190.55 | |
Harvard Pilgrim
| Professional | $104.71 | $104.71 | $104.71 | |
Martin's Point
| Professional | $190.55 | $190.55 | $190.55 | |
United
| Professional | $104.71 | $104.71 | $104.71 |