| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $5,558.78 | $10,900.00 | $14,552.94 | |
Moda Health
| Facility | $1,915.00 | $10,162.50 | $14,227.50 | |
Providence
| Facility | $1,915.00 | $10,162.50 | $14,227.50 |
Gstrct Prtl Dstl W/Roux-En-Y Rcnstj
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $5,558.78 | $10,900.00 | $14,552.94 | |
Moda Health
| Facility | $1,915.00 | $10,162.50 | $14,227.50 | |
Providence
| Facility | $1,915.00 | $10,162.50 | $14,227.50 |