| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $4,500.00 | $4,500.00 | $5,519.00 | |
Aetna
| Professional | $4,500.00 | $4,500.00 | $4,500.00 | |
Molina
| Professional | $30.00 | $78.00 | $3,900.00 | |
Regence BlueShield
| Facility | $72.20 | $93.82 | $126.32 |