| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $245.47 | $245.47 | $245.47 | |
Aetna
| Professional | $204.17 | $245.47 | $323.59 | |
Health Alliance Plan
| Facility | $245.47 | $245.47 | $245.47 | |
Health Alliance Plan
| Professional | $204.17 | $245.47 | $323.59 |