| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $103.52 | $103.52 | $103.52 | |
Aetna
| Professional | $96.72 | $96.72 | $103.52 | |
Cigna
| Professional | $58.65 | $58.65 | $58.65 | |
Moda Health
| Facility | $96.72 | $96.72 | $138.31 | |
Molina
| Professional | $30.00 | $30.00 | $3,900.00 |