| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $924.43 | $6,541.00 | $13,413.92 | |
Aetna
| Facility | 52 | $145.41 | $145.41 | $1,404.93 |
Moda Health
| Facility | $122.55 | $677.85 | $6,411.90 | |
Providence
| Facility | $122.55 | $677.85 | $6,411.90 |