| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $4,200.77 | $4,200.77 | $7,574.11 | |
Aetna
| Professional | $9,804.54 | $9,804.54 | $9,804.54 | |
Harvard Pilgrim
| Professional | $24,940.52 | $24,940.52 | $24,940.52 | |
Martin's Point
| Facility | $4,200.77 | $4,200.77 | $7,574.11 |