| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $57.67 | $57.67 | $57.67 | |
Aetna
| Professional | $57.67 | $57.67 | $57.67 | |
Moda Health
| Facility | $57.67 | $57.67 | $73.81 | |
Molina
| Professional | $30.00 | $78.00 | $3,900.00 | |
United
| Professional | $62.92 | $62.92 | $223.70 |