| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $65.91 | $65.91 | $65.91 | |
Aetna
| Professional | $65.91 | $65.91 | $65.91 | |
Molina
| Professional | $30.00 | $30.00 | $78.00 | |
Regence BlueShield
| Facility | $79.05 | $103.84 | $132.86 |