| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $376.69 | $376.69 | $478.40 | |
Aetna
| Professional | $251.12 | $376.69 | $376.69 | |
Martin's Point
| Facility | $376.69 | $478.40 | $911.04 | |
Martin's Point
| Professional | $251.12 | $376.69 | $376.69 |