| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $283.36 | $283.36 | $283.36 | |
Aetna
| Professional | $62.50 | $135.00 | $135.00 | |
Molina
| Professional | $30.00 | $45.00 | $60.00 | |
Regence BlueShield
| Facility | $297.07 | $379.59 | $553.17 |