| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $2,747.00 | $7,920.26 | $20,400.00 | |
Aetna
| Professional | $132.05 | $3,024.82 | $7,010.31 | |
Pacific Source
| Facility | $495.18 | $949.00 | $1,520.00 | |
Regence BlueShield
| Facility | $1,578.09 | $2,064.48 | $2,604.89 | |
United
| Facility | $1,106.00 | $2,385.00 | $7,480.00 |