| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $490.00 | $2,371.00 | $7,799.00 | |
Aetna
| Professional | $36.00 | $36.00 | $36.00 | |
Martin's Point
| Facility | $617.00 | $2,371.00 | $8,017.00 | |
Martin's Point
| Professional | $36.00 | $36.00 | $1,978.00 | |
United
| Facility | $144.00 | $674.00 | $4,300.00 |