| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $9,285.00 | $10,900.00 | $14,552.94 | |
Aetna
| Professional | $825.00 | $825.00 | $825.00 | |
Moda Health
| Facility | $825.00 | $1,155.00 | $1,179.75 | |
Providence
| Facility | $825.00 | $1,155.00 | $1,179.75 |