| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $4,952.33 | $7,470.03 | $16,321.54 | |
Aetna
| Facility | 50 | $6,547.39 | $6,823.08 | $11,555.44 |
Martin's Point
| Facility | $6,603.83 | $14,262.77 | $21,439.98 | |
Martin's Point
| Facility | 50 | $6,547.39 | $6,823.08 | $11,555.44 |