| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $8,836.00 | $10,480.00 | $13,413.92 | |
Aetna
| Professional | $367.50 | $367.50 | $367.50 | |
Moda Health
| Facility | $367.50 | $514.50 | $525.53 | |
Providence
| Facility | $367.50 | $514.50 | $525.53 |