| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $8,859.40 | $10,900.00 | $13,438.49 | |
Aetna
| Facility | 52 | $1,938.40 | $1,938.40 | $1,938.40 |
Moda Health
| Facility | $1,335.90 | $7,087.52 | $9,922.53 | |
Providence
| Facility | $1,335.90 | $7,087.52 | $9,922.53 |