| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $2,236.00 | $9,774.00 | $14,552.94 | |
Moda Health
| Facility | $920.20 | $4,189.10 | $5,990.43 | |
Providence
| Facility | $920.20 | $4,189.10 | $5,990.43 | |
United
| Facility | $6,295.00 | $6,295.00 | $6,295.00 |