| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $660.69 | $4,897.79 | $4,897.79 | |
Aetna
| Professional | $660.69 | $660.69 | $1,230.27 | |
Health Alliance Plan
| Facility | $660.69 | $4,897.79 | $6,918.31 | |
Health Alliance Plan
| Professional | $660.69 | $660.69 | $1,380.38 | |
United
| Facility | $1,148.15 | $3,019.95 | $6,025.60 |