| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $3.98 | $3.98 | $3.98 | |
Aetna
| Professional | $3.98 | $3.98 | $3.98 | |
Moda Health
| Facility | $3.98 | $3.98 | $6.31 | |
Moda Health
| Professional | $3.98 | $3.98 | $3.98 | |
Molina
| Professional | $30.20 | $30.20 | $30.20 |