| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $805.20 | $2,747.00 | $8,247.00 | |
Aetna
| Professional | $805.20 | $805.20 | $805.20 | |
Martin's Point
| Facility | $832.00 | $4,761.00 | $8,427.00 | |
Martin's Point
| Professional | $805.20 | $805.20 | $1,426.00 | |
United
| Facility | $448.00 | $2,391.00 | $6,322.00 |