| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $4,933.00 | $4,933.00 | $6,906.00 | |
Aetna
| Professional | $13,029.00 | $17,383.00 | $22,584.00 | |
Health Alliance Plan
| Facility | $4,933.00 | $4,933.00 | $6,906.00 | |
Health Alliance Plan
| Professional | $4,933.00 | $4,933.00 | $13,029.00 | |
United
| Facility | $6,850.00 | $11,464.00 | $15,011.00 |