| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $7,384.00 | $9,663.60 | $17,884.88 | |
Aetna
| Facility | 52 | $983.57 | $983.57 | $983.57 |
Moda Health
| Facility | $833.45 | $3,578.99 | $5,117.96 | |
Providence
| Facility | $833.45 | $3,578.99 | $5,117.96 |