| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $143.38 | $143.38 | $143.38 | |
Aetna
| Professional | $88.35 | $139.94 | $143.38 | |
Health Alliance Plan
| Facility | $143.38 | $143.38 | $143.38 | |
Health Alliance Plan
| Professional | $100.89 | $143.38 | $143.38 | |
United
| Professional | $167.94 | $199.12 | $284.16 |