| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $955.42 | $1,671.55 | $8,254.79 | |
Aetna
| Facility | 50 | $1,612.31 | $9,904.66 | $11,053.26 |
Martin's Point
| Facility | $955.42 | $3,985.61 | $29,262.70 | |
Martin's Point
| Facility | 50 | $1,227.32 | $8,903.01 | $18,292.40 |