| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $700.00 | $700.00 | $700.00 | |
Aetna
| Professional | $87.65 | $700.00 | $700.00 | |
Molina
| Professional | $30.00 | $45.00 | $60.00 | |
Regence BlueShield
| Facility | $50.61 | $67.17 | $103.32 |