| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $540.29 | $3,038.00 | $4,626.00 | |
Aetna
| Facility | 54 | $405.22 | $405.22 | $431.45 |
Regence BlueShield
| Facility | $2,304.17 | $3,047.35 | $4,440.85 | |
United
| Facility | $1,106.00 | $1,649.00 | $2,824.00 |