| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $75.40 | $93.25 | $513.00 | |
Aetna
| Professional | $60.00 | $94.00 | $150.00 | |
Pacific Source
| Facility | $79,999.20 | $79,999.20 | $79,999.20 | |
Providence
| Facility | $2,400,000.00 | $2,400,000.00 | $2,400,000.00 | |
Providence
| Professional | $150.00 | $2,250,000.00 | $2,400,000.00 |