| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $212.83 | $212.83 | $212.83 | |
Aetna
| Professional | $104.22 | $104.22 | $212.83 | |
Moda Health
| Facility | $104.22 | $104.22 | $133.40 | |
Regence BlueShield
| Facility | $222.25 | $410.36 | $606.97 |