| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $18.07 | $18.07 | $18.07 | |
Aetna
| Professional | $18.07 | $18.07 | $18.07 | |
Martin's Point
| Facility | $18.07 | $18.07 | $18.07 | |
Martin's Point
| Professional | $18.07 | $18.07 | $18.07 |