| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $14.28 | $2,128.17 | $2,128.17 | |
Aetna
| Professional | $11.16 | $11.16 | $2,128.17 | |
Moda Health
| Facility | $11.16 | $11.16 | $14.28 | |
Molina
| Professional | $30.00 | $30.00 | $55.00 |