| 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 | $776.70 | $3,978.72 | $5,570.21 | |
Providence
| Facility | $776.70 | $3,978.72 | $5,570.21 | |
United
| Facility | $14,287.46 | $14,287.46 | $14,287.46 |