| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $8,893.00 | $11,709.00 | $24,267.25 | |
Aetna
| Professional | $912.27 | $912.27 | $912.27 | |
Moda Health
| Facility | $912.27 | $1,277.18 | $1,304.55 | |
Providence
| Facility | $912.27 | $1,277.18 | $1,304.55 |