| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $18.20 | $18.20 | $31.62 | |
Moda Health
| Facility | $18.20 | $18.20 | $35.48 | |
Moda Health
| Professional | $18.20 | $18.20 | $1,202.26 | |
Providence
| Facility | $18.20 | $18.20 | $52.48 | |
Providence
| Professional | $60.26 | $60.26 | $60.26 |