| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $211.62 | $3,895.00 | $9,286.37 | |
Aetna
| Facility | 52 | $105.81 | $105.81 | $105.81 |
Regence BlueShield
| Facility | $2,686.94 | $3,607.85 | $5,257.67 | |
United
| Facility | $1,689.00 | $2,312.00 | $4,640.00 |