| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $4,933.00 | $4,933.00 | $4,933.00 | |
Health Alliance Plan
| Facility | $4,933.00 | $4,933.00 | $4,933.00 | |
Health Alliance Plan
| Professional | $4,933.00 | $4,933.00 | $4,933.00 | |
Molina
| Professional | $30.00 | $30.00 | $50.00 | |
United
| Facility | $1,906.00 | $4,645.00 | $6,327.00 |