| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $2,742.91 | $10,900.00 | $14,552.94 | |
Moda Health
| Facility | $1,135.74 | $4,470.82 | $6,393.27 | |
Providence
| Facility | $1,135.74 | $4,470.82 | $6,393.27 | |
United
| Facility | $11,831.32 | $11,831.32 | $11,831.32 |