| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,559.96 | $4,754.18 | $6,879.07 | |
Aetna
| Facility | 50 | $6,136.61 | $7,643.41 | $15,851.09 |
Martin's Point
| Facility | $1,559.96 | $4,754.18 | $19,848.82 | |
Martin's Point
| Facility | 50 | $3,936.36 | $7,643.41 | $22,864.32 |