| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $631.22 | $2,201.28 | $2,201.28 | |
Aetna
| Facility | 50 | $7,703.63 | $7,703.63 | $17,880.22 |
Martin's Point
| Facility | $2,201.28 | $2,201.28 | $2,201.28 | |
Martin's Point
| Facility | 50 | $7,703.63 | $7,703.63 | $17,880.22 |