| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $7,124.68 | $7,124.68 | $7,124.68 | |
Aetna
| Professional | $7,124.68 | $7,961.62 | $7,961.62 | |
Moda Health
| Facility | $3,775.00 | $7,961.62 | $7,961.62 | |
Molina
| Professional | $30.00 | $30.00 | $55.00 |