| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $924.43 | $7,340.00 | $14,552.94 | |
Aetna
| Facility | 52 | $280.73 | $280.73 | $623.44 |
Moda Health
| Facility | $237.10 | $1,281.24 | $2,845.26 | |
Providence
| Facility | $237.10 | $1,281.24 | $2,845.26 |