| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $9,772.37 | $12,022.64 | $16,595.87 | |
Aetna
| Professional | $14,125.38 | $14,125.38 | $16,595.87 | |
Moda Health
| Professional | $60.26 | $60.26 | $60.26 | |
Providence
| Professional | $60.26 | $60.26 | $60.26 |