| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $537.03 | $537.03 | $537.03 | |
Moda Health
| Professional | $537.03 | $537.03 | $537.03 | |
Molina
| Professional | $30.20 | $30.20 | $30.20 | |
Providence
| Professional | $79.43 | $79.43 | $79.43 |