| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $56.00 | $56.00 | $799.52 | |
Aetna
| Professional | AA | $262.00 | $1,237.33 | $1,808.42 |
Regence BlueShield
| Professional | QK | $231.34 | $276.27 | $320.52 |
Regence BlueShield
| Professional | QX | $231.34 | $276.27 | $320.52 |