| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $4,897.79 | $4,897.79 | $4,897.79 | |
Aetna
| Professional | $3.72 | $3.72 | $3.72 | |
Health Alliance Plan
| Facility | $4,897.79 | $4,897.79 | $6,918.31 | |
Health Alliance Plan
| Professional | $3.72 | $3.72 | $3.72 | |
United
| Facility | $549.54 | $1,862.09 | $4,073.80 |