| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $4,513.00 | $9,687.67 | $14,552.94 | |
Aetna
| Facility | 52 | $861.89 | $861.89 | $861.89 |
Aetna
| Facility | 53 | $344.75 | $344.75 | $344.75 |
Moda Health
| Facility | $799.28 | $1,409.55 | $2,015.66 | |
Providence
| Facility | $799.28 | $1,409.55 | $2,015.66 |