| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $2,236.00 | $10,900.00 | $20,143.00 | |
Moda Health
| Facility | $386.58 | $2,035.45 | $2,849.63 | |
Providence
| Facility | $386.58 | $2,035.45 | $2,849.63 | |
United
| Facility | $5,484.78 | $5,484.78 | $5,484.78 |