| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $4,933.00 | $4,933.00 | $6,907.00 | |
Aetna
| Professional | $16,643.00 | $22,206.00 | $28,850.00 | |
Health Alliance Plan
| Facility | $4,933.00 | $4,933.00 | $6,907.00 | |
Health Alliance Plan
| Professional | $4,933.00 | $4,933.00 | $16,643.00 | |
United
| Facility | $5,000.00 | $10,192.00 | $14,705.00 |