| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $5,221.95 | $10,900.00 | $14,552.94 | |
Aetna
| Facility | 52 | $2,610.98 | $2,610.98 | $2,610.98 |
Moda Health
| Facility | $1,806.84 | $9,546.75 | $13,365.45 | |
Providence
| Facility | $1,806.84 | $9,546.75 | $13,365.45 |