| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $3,741.00 | $10,175.36 | $13,413.92 | |
Aetna
| Facility | 50 | $5,322.63 | $5,322.63 | $5,322.63 |
Moda Health
| Facility | $408.52 | $1,810.07 | $2,588.40 | |
Providence
| Facility | $408.52 | $1,810.07 | $2,588.40 |