| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $21,537.00 | $21,537.00 | $21,537.00 | |
Aetna
| Professional | $1,557.09 | $1,557.09 | $21,537.00 | |
Moda Health
| Facility | $1,557.09 | $3,044.76 | $3,814.25 | |
Molina
| Professional | $55.00 | $55.00 | $78.00 |