| 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 | $870.35 | $1,046.36 | $5,670.64 | |
Providence
| Facility | $1,046.36 | $1,046.36 | $5,670.64 | |
United
| Facility | $4,665.92 | $4,665.92 | $4,665.92 |