| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $700.88 | $700.88 | $700.88 | |
Aetna
| Professional | $700.88 | $855.25 | $1,136.89 | |
Moda Health
| Facility | $855.25 | $855.25 | $1,094.72 | |
Molina
| Professional | $30.00 | $30.00 | $613.69 | |
Regence BlueShield
| Facility | $1,443.37 | $1,983.04 | $2,470.40 |