| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $170.74 | $170.74 | $170.74 | |
Cigna
| Facility | $52.17 | $52.17 | $52.17 | |
Cigna
| Professional | $38.08 | $52.17 | $53.74 | |
Moda Health
| Facility | $28.81 | $28.81 | $28.81 | |
Moda Health
| Professional | $55.88 | $187.58 | $296.18 | |
Providence
| Facility | $28.81 | $28.81 | $52.17 | |
Providence
| Professional | $38.08 | $53.74 | $133.27 | |
United
| Professional | $103.82 | $198.98 | $259.55 |