| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $632.45 | $6,541.00 | $13,413.92 | |
Moda Health
| Facility | $177.53 | $604.47 | $1,462.72 | |
Providence
| Facility | $213.42 | $664.92 | $1,462.72 | |
United
| Facility | $6,878.02 | $6,878.02 | $6,878.02 |