| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $190.55 | $190.55 | $190.55 | |
Aetna
| Professional | $147.91 | $181.97 | $234.42 | |
Health Alliance Plan
| Facility | $190.55 | $190.55 | $190.55 | |
Health Alliance Plan
| Professional | $151.36 | $190.55 | $234.42 |