| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $3,662.99 | $10,202.71 | $14,552.94 | |
Aetna
| Facility | 50 | $17,324.61 | $17,324.61 | $17,324.61 |
Moda Health
| Facility | $1,227.16 | $6,051.20 | $8,471.68 | |
Providence
| Facility | $1,227.16 | $6,051.20 | $8,471.68 |