| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $400.45 | $3,534.00 | $5,743.00 | |
Aetna
| Facility | 52 | $200.23 | $200.23 | $200.23 |
Regence BlueShield
| Facility | $2,686.94 | $3,607.85 | $5,257.67 | |
United
| Facility | $1,689.00 | $2,312.00 | $4,640.00 |