| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $175.28 | $175.28 | $175.28 | |
Moda Health
| Facility | $175.28 | $175.28 | $508.31 | |
Providence
| Facility | $175.28 | $175.28 | $508.31 | |
Providence
| Professional | $1,800,000.00 | $1,800,000.00 | $2,400,000.00 |