| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $8,453.33 | $10,945.89 | $17,336.30 | |
Aetna
| Facility | 50 | $14,088.88 | $14,088.88 | $14,088.88 |
Martin's Point
| Facility | $9,128.50 | $14,822.98 | $20,578.34 | |
Martin's Point
| Facility | 50 | $14,088.88 | $14,088.88 | $14,088.88 |