| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $212.34 | $212.34 | $212.34 | |
Aetna
| Professional | $212.34 | $212.34 | $212.34 | |
Moda Health
| Facility | $212.34 | $212.34 | $270.73 | |
Molina
| Professional | $30.00 | $55.00 | $3,900.00 | |
Regence BlueShield
| Facility | $154.33 | $585.88 | $984.72 |