| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $144.54 | $144.54 | $144.54 | |
Aetna
| Professional | $100.00 | $144.54 | $177.83 | |
Health Alliance Plan
| Facility | $144.54 | $144.54 | $144.54 | |
Health Alliance Plan
| Professional | $107.15 | $144.54 | $162.18 | |
United
| Professional | $162.18 | $199.53 | $257.04 |