| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $2,236.00 | $13,413.92 | $20,143.00 | |
Moda Health
| Facility | $669.19 | $3,474.16 | $4,863.82 | |
Providence
| Facility | $669.19 | $3,474.16 | $4,863.82 | |
United
| Facility | $6,486.14 | $6,486.14 | $6,486.14 |