| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $4,897.79 | $4,897.79 | $4,897.79 | |
Aetna
| Professional | $707.95 | $707.95 | $707.95 | |
Health Alliance Plan
| Facility | $4,897.79 | $4,897.79 | $6,918.31 | |
Health Alliance Plan
| Professional | $707.95 | $707.95 | $707.95 | |
United
| Facility | $234.42 | $891.25 | $1,737.80 |