| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $56.00 | $56.00 | $499.70 | |
Aetna
| Professional | QZ | $508.20 | $508.20 | $508.20 |
Regence BlueShield
| Professional | QX | $144.59 | $172.68 | $200.33 |
Regence BlueShield
| Professional | QY | $144.59 | $172.68 | $200.33 |