| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $2,187.76 | $2,187.76 | $2,187.76 | |
Aetna
| Facility | 50 | $17,782.79 | $18,197.01 | $18,197.01 |
Martin's Point
| Facility | $2,187.76 | $2,187.76 | $2,187.76 | |
Martin's Point
| Facility | 50 | $17,782.79 | $17,782.79 | $18,197.01 |