| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $3,768.95 | $3,768.95 | $7,441.66 | |
Aetna
| Professional | $3,768.95 | $3,768.95 | $3,768.95 | |
Martin's Point
| Facility | $3,768.95 | $7,441.66 | $7,462.52 | |
Martin's Point
| Professional | $3,768.95 | $3,768.95 | $4,720.00 |