| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $2,706.60 | $2,706.60 | $2,706.60 | |
Aetna
| Professional | $855.25 | $855.25 | $855.25 | |
Moda Health
| Facility | $855.25 | $855.25 | $1,223.01 | |
Providence
| Facility | $855.25 | $855.25 | $1,223.01 | |
Providence
| Professional | $2,250,000.00 | $2,250,000.00 | $2,400,000.00 |