| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $5,587.92 | $11,709.00 | $16,713.96 | |
Aetna
| Facility | 52 | $1,127.33 | $1,127.33 | $1,127.33 |
Aetna
| Facility | 53 | $450.94 | $450.94 | $450.94 |
Moda Health
| Facility | $939.76 | $4,330.55 | $6,192.69 | |
Providence
| Facility | $939.76 | $4,330.55 | $6,192.69 |