| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $2,236.00 | $9,813.00 | $14,552.94 | |
Aetna
| Facility | 50 | $4,183.28 | $4,183.28 | $12,875.20 |
Moda Health
| Facility | $555.64 | $2,158.26 | $3,086.31 | |
Providence
| Facility | $555.64 | $2,158.26 | $3,086.31 |