| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $3,417.44 | $13,413.92 | $20,143.00 | |
Moda Health
| Facility | $1,592.48 | $3,077.26 | $4,400.47 | |
Providence
| Facility | $1,592.48 | $3,077.26 | $4,400.47 | |
United
| Facility | $11,403.04 | $11,403.04 | $11,403.04 |