| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $40.11 | $40.11 | $40.11 | |
Aetna
| Professional | $40.11 | $92.04 | $94.00 | |
Moda Health
| Facility | $42.12 | $92.04 | $95.00 | |
Molina
| Professional | $1,500.00 | $1,500.00 | $1,500.00 |