| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $77.67 | $77.67 | $77.67 | |
Aetna
| Professional | $17.10 | $17.10 | $77.67 | |
Moda Health
| Facility | $17.10 | $17.96 | $36.77 | |
Molina
| Professional | $30.00 | $55.00 | $3,900.00 | |
Regence BlueShield
| Facility | $115.45 | $149.00 | $184.73 |