| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,000.00 | $1,000.00 | $1,000.00 | |
Aetna
| Professional | $707.95 | $707.95 | $1,348.96 | |
Moda Health
| Facility | $707.95 | $724.44 | $1,479.11 | |
Moda Health
| Professional | $707.95 | $707.95 | $1,348.96 | |
Molina
| Professional | $30.20 | $30.20 | $30.20 |