| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $190.55 | $190.55 | $190.55 | |
Aetna
| Professional | $190.55 | $190.55 | $190.55 | |
Cigna
| Professional | $190.55 | $190.55 | $190.55 | |
Select Health
| Professional | $162.18 | $199.53 | $199.53 | |
U of Utah Health Plan
| Professional | $162.18 | $190.55 | $229.09 | |
United
| Professional | $169.82 | $199.53 | $204.17 |