| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $6,677.16 | $6,677.16 | $6,677.16 | |
Aetna
| Facility | 50 | $3,057.36 | $3,057.36 | $7,985.36 |
Martin's Point
| Facility | $6,677.16 | $6,677.16 | $6,677.16 | |
Martin's Point
| Facility | 50 | $3,057.36 | $3,057.36 | $7,985.36 |