| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $3.75 | $3.75 | $3.75 | |
Capital Blue Cross
| Facility | $5,000.00 | $8,639.91 | $79,506.39 | |
Capital Blue Cross
| Professional | $32.72 | $38.50 | $38.50 | |
Martin's Point
| Professional | $3.75 | $3.75 | $3.75 |