| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $503.22 | $745.21 | $903.60 | |
Aetna
| Facility | 50 | $825.48 | $1,297.03 | $2,068.71 |
Martin's Point
| Facility | $503.22 | $548.50 | $903.60 | |
Martin's Point
| Facility | 50 | $825.48 | $1,297.03 | $15,154.01 |