| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $52.48 | $52.48 | $69.18 | |
Aetna
| Professional | $30.20 | $47.86 | $97.72 | |
Health Alliance Plan
| Facility | $52.48 | $52.48 | $67.61 | |
Health Alliance Plan
| Professional | $41.69 | $60.26 | $100.00 | |
United
| Professional | $41.69 | $53.70 | $79.43 |