| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $5.00 | $5.00 | $5.00 | |
Aetna
| Professional | $5.00 | $5.00 | $5.00 | |
Cigna
| Professional | $31.24 | $31.24 | $31.24 | |
Moda Health
| Facility | $5.00 | $5.00 | $6.40 | |
Molina
| Professional | $30.00 | $2,000.00 | $3,900.00 |