| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $508.74 | $508.74 | $508.74 | |
Aetna
| Professional | $146.74 | $146.74 | $508.74 | |
Moda Health
| Facility | $146.74 | $154.08 | $315.49 | |
Molina
| Professional | $30.00 | $55.00 | $3,900.00 | |
Regence BlueShield
| Facility | $182.82 | $292.52 | $362.58 |