| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $538.19 | $2,922.00 | $4,387.00 | |
Aetna
| Facility | 54 | $403.64 | $403.64 | $403.64 |
Regence BlueShield
| Facility | $2,304.17 | $3,047.35 | $4,440.85 | |
United
| Facility | $1,689.00 | $2,312.00 | $4,640.00 |