| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $566.24 | $566.24 | $566.24 | |
Aetna
| Professional | $566.24 | $575.28 | $655.69 | |
Moda Health
| Facility | $575.28 | $575.28 | $750.00 | |
Molina
| Professional | $30.00 | $1,500.00 | $3,500.00 |