| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $44.67 | $44.67 | $44.67 | |
Aetna
| Professional | $44.67 | $44.67 | $44.67 | |
Cigna
| Facility | $380.19 | $380.19 | $380.19 | |
Cigna
| Professional | $275.42 | $275.42 | $380.19 | |
Moda Health
| Facility | $44.67 | $44.67 | $57.54 | |
Moda Health
| Professional | $44.67 | $44.67 | $44.67 | |
Molina
| Professional | $30.20 | $30.20 | $77.62 | |
United
| Facility | $489.78 | $489.78 | $489.78 |