| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | AA | $524.81 | $616.60 | $977.24 |
Aetna
| Professional | QX | $245.47 | $363.08 | $537.03 |
Aetna
| Professional | QY | $269.15 | $269.15 | $389.05 |
Regence BlueShield
| Professional | QX | $114.82 | $141.25 | $177.83 |
Regence BlueShield
| Professional | QY | $114.82 | $141.25 | $177.83 |