| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $501.31 | $3,301.55 | $12,132.11 | |
Aetna
| Facility | 50 | $10,810.29 | $10,810.29 | $10,810.29 |
Martin's Point
| Facility | $183.94 | $5,740.80 | $14,225.16 | |
Martin's Point
| Facility | 50 | $10,810.29 | $10,810.29 | $10,810.29 |