| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $3,741.00 | $10,480.00 | $13,413.92 | |
Aetna
| Facility | 52 | $320.49 | $320.49 | $320.49 |
Moda Health
| Facility | $214.71 | $1,171.82 | $1,640.55 | |
Providence
| Facility | $214.71 | $1,171.82 | $1,640.55 |