| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $1,202.26 | $1,202.26 | $1,202.26 | |
Moda Health
| Facility | $1,202.26 | $1,202.26 | $1,318.26 | |
Moda Health
| Professional | $1,202.26 | $1,202.26 | $1,202.26 | |
Providence
| Facility | $1,318.26 | $1,318.26 | $1,318.26 |