| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $2,236.00 | $9,813.00 | $17,617.16 | |
Aetna
| Facility | 50 | $0.65 | $0.65 | $0.65 |
Moda Health
| Facility | $977.08 | $3,902.48 | $5,580.55 | |
Providence
| Facility | $977.08 | $3,902.48 | $5,580.55 |