| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $672.49 | $672.49 | $672.49 | |
Aetna
| Professional | $517.29 | $517.29 | $605.00 | |
Moda Health
| Facility | $517.29 | $724.22 | $739.74 | |
Providence
| Facility | $517.29 | $724.22 | $739.74 |