| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $4,897.79 | $4,897.79 | $6,309.57 | |
Aetna
| Professional | $251.19 | $691.83 | $1,412.54 | |
Health Alliance Plan
| Facility | $4,897.79 | $4,897.79 | $6,918.31 | |
Health Alliance Plan
| Professional | $251.19 | $691.83 | $1,412.54 | |
United
| Facility | $181.97 | $794.33 | $1,737.80 |