| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $121.48 | $2,910.00 | $4,387.00 | |
Aetna
| Facility | 54 | $91.11 | $91.11 | $114.19 |
Regence BlueShield
| Facility | $340.97 | $447.13 | $651.60 | |
United
| Facility | $1,078.00 | $1,556.00 | $4,495.00 |