| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $5,101.55 | $10,900.00 | $14,552.94 | |
Aetna
| Facility | 52 | $2,550.78 | $2,550.78 | $2,550.78 |
Moda Health
| Facility | $1,753.17 | $9,326.62 | $13,057.28 | |
Providence
| Facility | $1,753.17 | $9,326.62 | $13,057.28 |