| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $2,459.00 | $10,900.00 | $14,552.94 | |
Aetna
| Facility | 52 | $1,229.50 | $1,229.50 | $1,229.50 |
Moda Health
| Facility | $842.73 | $4,495.54 | $6,293.76 | |
Providence
| Facility | $842.73 | $4,495.54 | $6,293.76 |