| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $208.93 | $208.93 | $208.93 | |
Aetna
| Professional | $147.91 | $194.98 | $229.09 | |
Health Alliance Plan
| Facility | $208.93 | $208.93 | $208.93 | |
Health Alliance Plan
| Professional | $138.04 | $204.17 | $218.78 |