| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $91.66 | $91.66 | $93.33 | |
Moda Health
| Facility | $91.66 | $91.66 | $144.36 | |
Moda Health
| Professional | $13,910.16 | $17,150.38 | $18,772.80 | |
Providence
| Facility | $91.66 | $91.66 | $144.36 |