| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $229.09 | $239.88 | $14,125.38 | |
Aetna
| Professional | $239.88 | $239.88 | $354.81 | |
Health Alliance Plan
| Facility | $229.09 | $239.88 | $14,125.38 | |
Health Alliance Plan
| Professional | $239.88 | $239.88 | $316.23 |