| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $18.20 | $18.20 | $18.20 | |
Aetna
| Professional | $18.20 | $18.20 | $18.20 | |
Moda Health
| Facility | $18.20 | $18.20 | $21.88 | |
Moda Health
| Professional | $18.20 | $18.20 | $18.20 | |
Providence
| Facility | $18.20 | $18.20 | $23.44 | |
Providence
| Professional | $60.26 | $79.43 | $79.43 |