| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $418.24 | $504.00 | $504.00 | |
Aetna
| Professional | AA | $611.04 | $611.04 | $611.04 |
Aetna
| Professional | QZ | $477.73 | $477.73 | $511.06 |
Regence BlueShield
| Professional | QK | $204.00 | $234.00 | $280.00 |
Regence BlueShield
| Professional | QX | $204.00 | $234.00 | $280.00 |