| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $25.12 | $25.12 | $25.12 | |
Moda Health
| Professional | $25.12 | $25.12 | $25.12 | |
Providence
| Professional | $15.85 | $15.85 | $79.43 | |
Regence BlueShield
| Facility | $398.11 | $398.11 | $398.11 |