| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $2,236.00 | $8,090.15 | $13,413.92 | |
Aetna
| Facility | 50 | $16,448.40 | $16,448.40 | $16,448.40 |
Moda Health
| Facility | $493.18 | $1,840.12 | $2,631.37 | |
Providence
| Facility | $493.18 | $1,840.12 | $2,631.37 |