| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $11,002.60 | $11,002.60 | $11,002.60 | |
Aetna
| Professional | $1,908.26 | $1,908.26 | $11,002.60 | |
Moda Health
| Facility | $1,908.26 | $2,501.75 | $3,121.20 | |
Molina
| Professional | $55.00 | $55.00 | $78.00 |