| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $830.52 | $7,817.20 | $12,920.00 | |
Aetna
| Facility | 52 | $415.26 | $415.26 | $415.26 |
Regence BlueShield
| Facility | $14,734.45 | $19,517.43 | $28,442.50 | |
United
| Facility | $3,028.00 | $9,753.00 | $15,824.00 |