| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $466.33 | $466.33 | $1,454.95 | |
Aetna
| Professional | $287.33 | $466.33 | $466.33 | |
Health Alliance Plan
| Facility | $466.33 | $492.62 | $1,101.70 | |
Health Alliance Plan
| Professional | $466.33 | $492.62 | $615.16 | |
United
| Facility | $508.04 | $508.04 | $508.04 | |
United
| Professional | $436.18 | $522.65 | $665.20 |