| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $687.89 | $687.89 | $4,126.95 | |
Aetna
| Facility | 50 | $825.48 | $825.48 | $943.30 |
Martin's Point
| Facility | $687.89 | $687.89 | $4,126.95 | |
Martin's Point
| Facility | 50 | $0.40 | $825.48 | $943.30 |