| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $4,039.01 | $10,149.75 | $21,391.00 | |
Aetna
| Facility | 52 | $2,019.51 | $2,019.51 | $9,445.20 |
Moda Health
| Facility | $1,326.96 | $6,850.32 | $9,590.45 | |
Providence
| Facility | $1,326.96 | $6,850.32 | $9,590.45 |