| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $11,081.07 | $11,081.07 | $11,081.07 | |
Aetna
| Professional | $6,840.00 | $11,983.98 | $23,152.50 | |
Health Alliance Plan
| Facility | $11,081.07 | $11,081.07 | $11,081.07 | |
Health Alliance Plan
| Professional | $6,840.00 | $11,983.98 | $23,152.50 | |
Molina
| Professional | $30.00 | $30.00 | $100.00 |