| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,114.26 | $1,114.26 | $2,476.44 | |
Aetna
| Facility | 50 | $1,513.21 | $4,126.95 | $4,586.04 |
Martin's Point
| Facility | $1,114.26 | $1,114.26 | $2,476.44 | |
Martin's Point
| Facility | 50 | $1,513.21 | $4,126.95 | $5,385.82 |