| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $85.11 | $85.11 | $85.11 | |
Aetna
| Professional | $85.11 | $85.11 | $102.33 | |
Anthem BCBS
| Professional | $21.38 | $28.84 | $46.77 | |
Martin's Point
| Professional | $85.11 | $85.11 | $162.18 |