| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $7,943.28 | $7,943.28 | $7,943.28 | |
Moda Health
| Facility | $7,943.28 | $7,943.28 | $20,417.38 | |
Moda Health
| Professional | $20,417.38 | $20,417.38 | $20,417.38 | |
Providence
| Professional | $70.79 | $79.43 | $79.43 | |
United
| Facility | $389.05 | $4,073.80 | $6,165.95 |