| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $2,122.59 | $6,541.00 | $13,413.92 | |
Aetna
| Facility | 50 | $8,360.29 | $8,360.29 | $8,360.29 |
Moda Health
| Facility | $2,643.10 | $3,700.34 | $3,779.63 | |
Providence
| Facility | $2,643.10 | $3,700.34 | $3,779.63 |