| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $987.52 | $987.52 | $987.52 | |
Aetna
| Professional | $640.00 | $640.00 | $1,820.00 | |
Moda Health
| Facility | $640.00 | $640.00 | $819.20 | |
Molina
| Professional | $30.00 | $78.00 | $3,900.00 |