| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $3,768.95 | $3,768.95 | $5,033.60 | |
Moda Health
| Facility | $3,768.95 | $3,957.40 | $5,163.46 | |
Pacific Source
| Facility | $79,999.20 | $79,999.20 | $79,999.20 | |
Providence
| Facility | $3,768.95 | $3,768.95 | $5,389.60 | |
Providence
| Professional | $2,250,000.00 | $2,250,000.00 | $2,400,000.00 |