| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $3,890.45 | $12,022.64 | $58,884.37 | |
Aetna
| Facility | 50 | $25,703.96 | $25,703.96 | $25,703.96 |
Moda Health
| Facility | $501.19 | $776.25 | $58,884.37 | |
Moda Health
| Facility | 50 | $25,703.96 | $25,703.96 | $25,703.96 |
Providence
| Facility | $501.19 | $776.25 | $3,890.45 |