| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $3,741.00 | $10,480.00 | $13,413.92 | |
Moda Health
| Facility | $568.71 | $2,974.74 | $4,164.64 | |
Providence
| Facility | $583.59 | $2,974.74 | $4,164.64 | |
United
| Facility | $5,724.10 | $5,724.10 | $5,724.10 |