| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $173.78 | $173.78 | $173.78 | |
Aetna
| Professional | $173.78 | $173.78 | $173.78 | |
Cigna
| Facility | $263.03 | $263.03 | $263.03 | |
Cigna
| Professional | $190.55 | $190.55 | $190.55 | |
Moda Health
| Facility | $173.78 | $173.78 | $263.03 | |
Moda Health
| Professional | $173.78 | $173.78 | $173.78 | |
Providence
| Facility | $173.78 | $173.78 | $263.03 | |
Providence
| Professional | $79.43 | $190.55 | $190.55 | |
United
| Facility | $251.19 | $251.19 | $251.19 |