| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $2,041.74 | $4,897.79 | $17,782.79 | |
Aetna
| Professional | $4,168.69 | $4,168.69 | $4,168.69 | |
Health Alliance Plan
| Facility | $2,041.74 | $4,897.79 | $6,918.31 | |
Health Alliance Plan
| Professional | $4,168.69 | $4,168.69 | $4,168.69 | |
United
| Facility | $181.97 | $831.76 | $1,862.09 |