| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $7,943.28 | $16,982.44 | $16,982.44 | |
Aetna
| Professional | $3,801.89 | $7,943.28 | $7,943.28 | |
Health Alliance Plan
| Facility | $7,943.28 | $7,943.28 | $16,982.44 | |
Health Alliance Plan
| Professional | $3,801.89 | $7,943.28 | $7,943.28 |