| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $354.81 | $3,019.95 | $4,570.88 | |
Aetna
| Facility | 50 | $912.01 | $912.01 | $912.01 |
Aetna
| Professional | 50 | $100.00 | $186.21 | $912.01 |
U of Utah Health Plan
| Professional | $165.96 | $346.74 | $549.54 | |
United
| Facility | $1,071.52 | $4,466.84 | $5,128.61 |