| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $9,285.00 | $10,900.00 | $14,552.94 | |
Aetna
| Professional | $3,135.99 | $3,135.99 | $3,135.99 | |
Moda Health
| Facility | $3,135.99 | $3,135.99 | $4,484.47 | |
Providence
| Facility | $3,135.99 | $3,135.99 | $4,484.47 |