| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,245.00 | $1,377.84 | $5,778.35 | |
Aetna
| Facility | 50 | $2,274.35 | $2,274.35 | $15,138.99 |
Martin's Point
| Facility | $1,245.00 | $1,377.84 | $5,778.35 | |
Martin's Point
| Facility | 50 | $2,274.35 | $9,849.92 | $15,138.99 |