| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $3,887.17 | $9,285.00 | $18,932.09 | |
Aetna
| Facility | 50 | $5,542.50 | $5,542.50 | $5,542.50 |
Moda Health
| Facility | $633.13 | $3,329.23 | $4,660.92 | |
Providence
| Facility | $633.13 | $3,329.23 | $4,660.92 |