| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $6,606.93 | $12,022.64 | $20,892.96 | |
Aetna
| Facility | 50 | $6,606.93 | $6,606.93 | $6,606.93 |
Martin's Point
| Facility | $6,606.93 | $12,022.64 | $20,892.96 | |
Martin's Point
| Facility | 50 | $6,606.93 | $6,606.93 | $6,606.93 |