| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $467.74 | $467.74 | $467.74 | |
Aetna
| Facility | 54 | $398.11 | $398.11 | $398.11 |
Martin's Point
| Facility | $467.74 | $467.74 | $467.74 | |
Martin's Point
| Facility | 54 | $398.11 | $398.11 | $398.11 |