| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $2,747.00 | $6,629.40 | $8,728.00 | |
Aetna
| Professional | $4,704.00 | $4,704.00 | $20,400.00 | |
Pacific Source
| Facility | $79,999.20 | $79,999.20 | $79,999.20 | |
Providence
| Facility | $2,400,000.00 | $2,400,000.00 | $2,400,000.00 | |
Providence
| Professional | $2,250,000.00 | $2,250,000.00 | $2,400,000.00 | |
United
| Facility | $376.00 | $4,113.00 | $6,216.00 |