| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $342.46 | $342.46 | $524.42 | |
Aetna
| Facility | 54 | $688.01 | $847.50 | $847.50 |
Martin's Point
| Facility | $302.54 | $342.46 | $524.42 | |
Martin's Point
| Facility | 54 | $390.79 | $688.01 | $1,193.64 |