| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $3,684.42 | $7,779.33 | $10,436.27 | |
Aetna
| Facility | 22 | $20,319.74 | $20,319.74 | $20,319.74 |
Martin's Point
| Facility | $3,684.42 | $7,870.94 | $25,723.67 | |
Martin's Point
| Facility | 22 | $20,319.74 | $20,319.74 | $20,319.74 |