| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $3,801.89 | $3,801.89 | $5,011.87 | |
Moda Health
| Facility | $3,801.89 | $3,801.89 | $3,981.07 | |
Moda Health
| Professional | $60.26 | $3,801.89 | $3,801.89 | |
Providence
| Facility | $3,801.89 | $3,801.89 | $4,168.69 | |
Providence
| Professional | $60.26 | $60.26 | $60.26 |