| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $0.02 | $0.02 | $0.02 | |
Moda Health
| Professional | $13,910.16 | $17,150.38 | $18,772.80 | |
Pacific Source
| Facility | $25.00 | $25.00 | $25.00 | |
Providence
| Facility | $600,000.00 | $600,000.00 | $600,000.00 |