| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $6.03 | $6.03 | $6.03 | |
Aetna
| Professional | $6.03 | $6.03 | $6.03 | |
Moda Health
| Facility | $6.03 | $6.03 | $9.55 | |
Moda Health
| Professional | $6.03 | $6.03 | $6.03 | |
Molina
| Professional | $30.20 | $30.20 | $30.20 |