| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $2,236.00 | $10,900.00 | $17,695.00 | |
Aetna
| Facility | 54 | $1,643.68 | $1,643.68 | $1,643.68 |
Moda Health
| Facility | $929.49 | $1,125.93 | $6,019.41 | |
Providence
| Facility | $1,125.93 | $1,125.93 | $6,019.41 |