| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $2,454.71 | $2,454.71 | $2,454.71 | |
Aetna
| Professional | $354.81 | $354.81 | $354.81 | |
Martin's Point
| Facility | $2,454.71 | $2,454.71 | $2,454.71 | |
Martin's Point
| Professional | $354.81 | $354.81 | $354.81 |