| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $4,273.05 | $9,774.00 | $14,552.94 | |
Aetna
| Facility | 52 | $2,136.53 | $2,136.53 | $2,136.53 |
Moda Health
| Facility | $1,796.02 | $7,774.30 | $11,117.25 | |
Providence
| Facility | $1,796.02 | $7,774.30 | $11,117.25 |