| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $25.00 | $25.00 | $25.00 | |
Moda Health
| Facility | $25.00 | $25.00 | $34.25 | |
Moda Health
| Professional | $17,728.12 | $17,728.12 | $17,728.12 | |
Providence
| Facility | $25.00 | $25.00 | $34.25 | |
Regence BlueShield
| Professional | $157.26 | $165.54 | $165.54 |