| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $443.71 | $443.71 | $443.71 | |
Aetna
| Professional | $443.71 | $443.71 | $443.71 | |
Molina
| Professional | $30.00 | $30.00 | $30.00 | |
Regence BlueShield
| Facility | $1,183.54 | $1,518.13 | $2,212.35 |