| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,125.84 | $1,125.84 | $1,125.84 | |
Aetna
| Professional | $239.37 | $239.37 | $1,125.84 | |
Moda Health
| Facility | $239.37 | $239.37 | $306.39 | |
Molina
| Professional | $30.00 | $30.00 | $55.00 |