| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $3,741.00 | $9,577.00 | $13,413.92 | |
Moda Health
| Facility | $679.32 | $3,023.87 | $4,233.42 | |
Providence
| Facility | $679.32 | $3,023.87 | $4,233.42 | |
United
| Facility | $6,489.22 | $6,489.22 | $6,489.22 |