| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $30.00 | $30.00 | $30.00 | |
Aetna
| Professional | $30.00 | $30.00 | $30.00 | |
Martin's Point
| Facility | $30.00 | $30.00 | $30.00 | |
Martin's Point
| Professional | $30.00 | $30.00 | $30.00 |