| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $3,741.00 | $10,480.00 | $13,413.92 | |
Aetna
| Facility | 50 | $4,609.27 | $4,609.27 | $4,609.27 |
Moda Health
| Facility | $471.11 | $1,827.56 | $2,613.41 | |
Providence
| Facility | $471.11 | $1,827.56 | $2,613.41 |