| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $575.44 | $575.44 | $758.58 | |
Moda Health
| Facility | $575.44 | $575.44 | $758.58 | |
Moda Health
| Professional | $79.43 | $575.44 | $630.96 | |
Providence
| Facility | $575.44 | $575.44 | $794.33 | |
Providence
| Professional | $79.43 | $79.43 | $79.43 |