| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $4,897.79 | $5,754.40 | $5,754.40 | |
Aetna
| Professional | $15,848.93 | $15,848.93 | $15,848.93 | |
Health Alliance Plan
| Facility | $4,897.79 | $5,754.40 | $6,918.31 | |
Health Alliance Plan
| Professional | $15,848.93 | $15,848.93 | $48,977.88 | |
United
| Facility | $6,918.31 | $12,589.25 | $37,153.52 |