| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $55.46 | $2,744.00 | $4,626.00 | |
Aetna
| Facility | 52 | $27.73 | $27.73 | $27.73 |
Aetna
| Facility | 53 | $11.09 | $11.09 | $11.09 |
Regence BlueShield
| Facility | $539.07 | $755.46 | $1,100.93 | |
United
| Facility | $658.00 | $4,445.00 | $4,912.00 |