| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $112.32 | $130.69 | $130.69 | |
Aetna
| Professional | $78.12 | $112.32 | $130.69 | |
Cigna
| Professional | $2.00 | $2.00 | $2.00 | |
Moda Health
| Facility | $112.32 | $112.32 | $130.69 | |
Molina
| Professional | $30.00 | $55.00 | $3,900.00 |