| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,348.96 | $1,348.96 | $1,348.96 | |
Aetna
| Professional | $407.38 | $602.56 | $1,445.44 | |
Moda Health
| Facility | $1,348.96 | $1,348.96 | $1,348.96 | |
Moda Health
| Professional | $446.68 | $691.83 | $1,445.44 | |
Molina
| Professional | $30.20 | $30.20 | $30.20 | |
United
| Professional | $309.03 | $309.03 | $741.31 |