| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $691.83 | $691.83 | $912.01 | |
Aetna
| Facility | 50 | $0.40 | $1,621.81 | $4,897.79 |
Martin's Point
| Facility | $691.83 | $691.83 | $912.01 | |
Martin's Point
| Facility | 50 | $0.40 | $933.25 | $4,897.79 |