| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $2,236.00 | $9,774.00 | $14,552.94 | |
Aetna
| Facility | 54 | $1,484.22 | $1,484.22 | $1,484.22 |
Moda Health
| Facility | $837.45 | $1,011.93 | $5,435.42 | |
Providence
| Facility | $1,011.93 | $1,011.93 | $5,435.42 |