| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $3,890.45 | $10,964.78 | $16,595.87 | |
Aetna
| Professional | $10,715.19 | $12,882.50 | $16,595.87 | |
Moda Health
| Professional | $60.26 | $60.26 | $60.26 | |
Providence
| Professional | $60.26 | $60.26 | $60.26 |