| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $30.54 | $72.98 | $72.98 | |
Aetna
| Professional | $30.54 | $30.54 | $72.98 | |
Cigna
| Professional | $150.94 | $150.94 | $150.94 | |
Moda Health
| Facility | $30.54 | $30.54 | $39.09 | |
Molina
| Professional | $30.00 | $55.00 | $3,900.00 |