| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $4,473.04 | $6,782.00 | $13,413.92 | |
Aetna
| Professional | $45.89 | $127.09 | $127.09 | |
Moda Health
| Facility | $45.89 | $65.62 | $177.93 | |
Providence
| Facility | $45.89 | $65.62 | $177.93 |