| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $3,741.00 | $10,480.00 | $13,413.92 | |
Moda Health
| Facility | $287.62 | $1,314.87 | $1,880.26 | |
Providence
| Facility | $287.62 | $1,314.87 | $1,880.26 | |
United
| Facility | $6,295.00 | $6,295.00 | $6,295.00 |