| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $87.57 | $87.57 | $755.47 | |
Moda Health
| Facility | $87.57 | $109.46 | $248.49 | |
Moda Health
| Professional | $1,848.96 | $1,848.96 | $1,848.96 | |
Premera BCBS
| Facility | $3,495.87 | $3,495.87 | $3,495.87 | |
Providence
| Facility | $87.57 | $91.95 | $133.97 |