| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $247.47 | $2,476.44 | $4,206.31 | |
Aetna
| Facility | 50 | $1,513.21 | $1,513.21 | $1,513.21 |
Martin's Point
| Facility | $2,476.44 | $2,476.44 | $4,206.31 | |
Martin's Point
| Facility | 50 | $1,513.21 | $1,513.21 | $1,513.21 |