| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $131.24 | $196.86 | $4,933.00 | |
Aetna
| Professional | $129.04 | $131.24 | $287.35 | |
Health Alliance Plan
| Facility | $131.24 | $310.06 | $4,933.00 | |
Health Alliance Plan
| Professional | $131.24 | $254.79 | $308.25 | |
United
| Professional | $193.75 | $246.85 | $345.59 |