| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $2,511.89 | $6,606.93 | $16,595.87 | |
Aetna
| Professional | $4,677.35 | $5,888.44 | $16,595.87 | |
Moda Health
| Professional | $60.26 | $60.26 | $60.26 | |
Providence
| Professional | $60.26 | $60.26 | $60.26 |