| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $742.74 | $1,100.64 | $1,100.64 | |
Aetna
| Facility | 50 | $24,280.22 | $24,280.22 | $24,280.22 |
Martin's Point
| Facility | $1,100.64 | $1,100.64 | $1,100.64 | |
Martin's Point
| Facility | 50 | $24,280.22 | $24,280.22 | $24,280.22 |