| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $2,396.59 | $7,731.90 | $16,277.26 | |
Aetna
| Facility | 50 | $6,036.30 | $6,291.36 | $11,692.39 |
Moda Health
| Facility | $810.71 | $3,114.53 | $4,453.78 | |
Providence
| Facility | $810.71 | $3,114.53 | $4,453.78 |