| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $102.33 | $102.33 | $102.33 | |
Health Alliance Plan
| Facility | $831.76 | $831.76 | $831.76 | |
Health Alliance Plan
| Professional | $7.41 | $7.41 | $102.33 | |
United
| Facility | $316.23 | $380.19 | $1,122.02 |