| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | AA | $616.91 | $616.91 | $969.43 |
Aetna
| Professional | QX | $65.02 | $65.02 | $65.02 |
Regence BlueShield
| Professional | QX | $115.67 | $138.13 | $160.26 |
Regence BlueShield
| Professional | QY | $115.67 | $138.13 | $160.26 |