| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $5,162.71 | $10,900.00 | $14,552.94 | |
Aetna
| Facility | 53 | $1,032.54 | $1,032.54 | $1,032.54 |
Moda Health
| Facility | $2,172.09 | $9,916.04 | $14,179.95 | |
Providence
| Facility | $2,172.09 | $9,916.04 | $14,179.95 |