| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $47.06 | $47.06 | $182.12 | |
Aetna
| Professional | $47.06 | $47.06 | $384.73 | |
Martin's Point
| Facility | $47.06 | $47.06 | $182.12 | |
Martin's Point
| Professional | $47.06 | $47.06 | $384.73 |