| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $159.81 | $159.81 | $159.81 | |
Aetna
| Professional | $61.55 | $64.00 | $159.81 | |
Moda Health
| Facility | $64.00 | $64.00 | $81.92 | |
Regence BlueShield
| Facility | $141.69 | $221.90 | $271.87 |