| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $22,032.00 | $22,032.00 | $22,032.00 | |
Aetna
| Professional | $376.69 | $376.69 | $376.69 | |
Moda Health
| Facility | $538.66 | $538.66 | $538.66 | |
Providence
| Facility | $538.66 | $538.66 | $538.66 |