| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $2,236.00 | $13,413.92 | $20,143.00 | |
Moda Health
| Facility | $742.64 | $3,387.57 | $4,844.22 | |
Providence
| Facility | $742.64 | $3,387.57 | $4,844.22 | |
United
| Facility | $10,811.40 | $10,811.40 | $10,811.40 |