| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $3,014.45 | $10,900.00 | $14,552.94 | |
Aetna
| Facility | 52 | $1,507.23 | $1,507.23 | $1,507.23 |
Moda Health
| Facility | $1,039.18 | $5,511.00 | $7,715.40 | |
Providence
| Facility | $1,039.18 | $5,511.00 | $7,715.40 |