| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1.26 | $1.26 | $1.60 | |
Aetna
| Professional | $1.26 | $1.26 | $1.26 | |
Capital Blue Cross
| Facility | $967.00 | $57,255.43 | $79,506.39 | |
Capital Blue Cross
| Professional | $27.78 | $28.83 | $28.83 | |
Martin's Point
| Facility | $1.26 | $1.26 | $1.60 | |
Martin's Point
| Professional | $1.26 | $1.26 | $1.26 |