| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | AA | $951.80 | $1,233.82 | $1,896.99 |
Regence BlueShield
| Professional | QX | $173.50 | $207.21 | $240.39 |
Regence BlueShield
| Professional | QY | $173.50 | $207.21 | $240.39 |