| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $2,236.00 | $9,774.00 | $20,723.00 | |
Aetna
| Facility | 50 | $2,057.00 | $8,400.16 | $41,741.05 |
Moda Health
| Facility | $1,329.11 | $5,311.03 | $7,594.77 | |
Providence
| Facility | $1,329.11 | $5,311.03 | $7,594.77 |