| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $2,398.83 | $2,398.83 | $4,897.79 | |
Moda Health
| Facility | $2,398.83 | $2,398.83 | $4,897.79 | |
Moda Health
| Professional | $60.26 | $2,398.83 | $4,897.79 | |
Providence
| Facility | $2,398.83 | $2,398.83 | $4,897.79 | |
Providence
| Professional | $60.26 | $60.26 | $60.26 |