| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $2,447.19 | $5,084.91 | $13,413.92 | |
Aetna
| Facility | 54 | $1,059.61 | $1,059.61 | $1,059.61 |
Moda Health
| Facility | $471.85 | $2,396.21 | $3,354.69 | |
Providence
| Facility | $471.85 | $2,396.21 | $3,354.69 |