| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $2,511.89 | $9,772.37 | $14,125.38 | |
Aetna
| Facility | 50 | $0.65 | $0.65 | $5,128.61 |
Moda Health
| Facility | $177.83 | $218.78 | $10,000.00 | |
Moda Health
| Facility | 50 | $0.65 | $0.65 | $5,128.61 |
Providence
| Facility | $177.83 | $218.78 | $1,513.56 |