| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,270.83 | $6,541.00 | $13,413.92 | |
Aetna
| Facility | 54 | $866.83 | $866.83 | $953.13 |
Moda Health
| Facility | $409.21 | $1,960.21 | $3,017.55 | |
Providence
| Facility | $418.46 | $1,960.21 | $3,017.55 |