| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $548.86 | $548.86 | $548.86 | |
Health Alliance Plan
| Professional | $506.00 | $548.86 | $548.86 | |
Molina
| Professional | $30.00 | $30.00 | $55.00 | |
United
| Professional | $4,800.00 | $4,800.00 | $5,092.80 |