| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $2.10 | $2.10 | $2.10 | |
Capital Blue Cross
| Facility | $5,000.00 | $8,639.91 | $79,506.39 | |
Capital Blue Cross
| Professional | $53.22 | $62.61 | $62.61 | |
Martin's Point
| Professional | $2.10 | $2.10 | $2.10 |