| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $81.59 | $81.59 | $103.63 | |
Aetna
| Professional | $81.59 | $81.59 | $81.59 | |
Martin's Point
| Facility | $81.59 | $81.59 | $103.63 | |
Martin's Point
| Professional | $76.80 | $81.59 | $81.59 |