| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $2,236.00 | $9,774.00 | $14,552.94 | |
Moda Health
| Facility | $589.12 | $3,002.10 | $4,202.93 | |
Providence
| Facility | $589.12 | $3,002.10 | $4,202.93 | |
United
| Facility | $6,489.22 | $6,489.22 | $6,489.22 |