| 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 | $2,630.27 | $3,090.30 | $4,897.79 | |
Health Alliance Plan
| Professional | $1,047.13 | $1,174.90 | $1,513.56 | |
United
| Facility | $234.42 | $891.25 | $1,737.80 |