| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $17.10 | $17.10 | $17.10 | |
Aetna
| Professional | $17.10 | $17.10 | $77.67 | |
Molina
| Professional | $30.00 | $45.00 | $60.00 | |
Regence BlueShield
| Facility | $94.11 | $118.45 | $168.46 |