| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $333.97 | $333.97 | $333.97 | |
Aetna
| Professional | $308.72 | $308.72 | $620.86 | |
Moda Health
| Facility | $455.42 | $469.08 | $582.94 | |
Molina
| Professional | $30.00 | $55.00 | $3,900.00 | |
Regence BlueShield
| Facility | $628.54 | $904.43 | $1,113.79 |