| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $69.20 | $69.20 | $87.90 | |
Aetna
| Professional | $69.20 | $69.20 | $69.20 | |
Martin's Point
| Facility | $69.20 | $69.20 | $87.90 | |
Martin's Point
| Professional | $65.14 | $69.20 | $69.20 |