| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $4,897.79 | $4,897.79 | $16,218.10 | |
Aetna
| Professional | $22,908.68 | $22,908.68 | $22,908.68 | |
Health Alliance Plan
| Facility | $4,897.79 | $4,897.79 | $16,218.10 | |
Health Alliance Plan
| Professional | $22,908.68 | $22,908.68 | $32,359.37 | |
United
| Facility | $5,011.87 | $10,000.00 | $23,442.29 |