| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $3,741.00 | $10,480.00 | $13,413.92 | |
Moda Health
| Facility | $878.16 | $1,093.20 | $5,661.80 | |
Providence
| Facility | $1,093.20 | $1,093.20 | $5,661.80 | |
United
| Facility | $7,542.00 | $7,542.00 | $7,542.00 |