| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $6,603.83 | $7,470.03 | $12,097.76 | |
Aetna
| Facility | 50 | $6,603.82 | $6,603.82 | $6,603.82 |
Martin's Point
| Facility | $6,603.83 | $11,122.65 | $20,733.80 | |
Martin's Point
| Facility | 50 | $6,603.82 | $6,603.82 | $6,603.82 |