| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $2,176.07 | $10,900.00 | $14,552.94 | |
Aetna
| Facility | 52 | $1,088.04 | $1,088.04 | $1,088.04 |
Moda Health
| Facility | $919.68 | $3,441.45 | $4,921.27 | |
Providence
| Facility | $919.68 | $3,441.45 | $4,921.27 |