| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,729.38 | $3,565.64 | $5,115.08 | |
Aetna
| Facility | 50 | $9,842.19 | $9,842.19 | $9,842.19 |
Martin's Point
| Facility | $1,729.38 | $3,565.64 | $10,561.25 | |
Martin's Point
| Facility | 50 | $9,842.19 | $9,842.19 | $9,842.19 |