| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $588.84 | $1,047.13 | $1,258.93 | |
Moda Health
| Facility | $588.84 | $1,047.13 | $2,041.74 | |
Moda Health
| Professional | $60.26 | $1,047.13 | $2,137.96 | |
Providence
| Facility | $691.83 | $1,047.13 | $2,137.96 | |
Providence
| Professional | $60.26 | $60.26 | $60.26 |