| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $4,473.04 | $9,176.04 | $14,552.94 | |
Aetna
| Professional | $627.98 | $627.98 | $627.98 | |
Moda Health
| Facility | $627.98 | $879.17 | $898.01 | |
Providence
| Facility | $627.98 | $879.17 | $898.01 |