| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $3,591.05 | $10,900.00 | $14,552.94 | |
Aetna
| Facility | 52 | $1,795.53 | $1,795.53 | $1,795.53 |
Moda Health
| Facility | $1,235.08 | $6,565.14 | $9,191.20 | |
Providence
| Facility | $1,235.08 | $6,565.14 | $9,191.20 |