| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $2,236.00 | $9,774.00 | $14,552.94 | |
Aetna
| Facility | 52 | $1,109.08 | $1,109.08 | $1,109.08 |
Moda Health
| Facility | $766.09 | $4,055.21 | $5,677.29 | |
Providence
| Facility | $766.09 | $4,055.21 | $5,677.29 |