| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $503.41 | $794.42 | $5,454.64 | |
Aetna
| Facility | 54 | $737.83 | $1,024.45 | $1,024.45 |
Martin's Point
| Facility | $250.32 | $758.41 | $5,454.64 | |
Martin's Point
| Facility | 54 | $543.27 | $737.83 | $1,024.45 |