| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $258.06 | $258.06 | $258.06 | |
Aetna
| Professional | $258.06 | $258.06 | $258.06 | |
Regence BlueShield
| Professional | $2,383.73 | $2,383.73 | $2,383.73 | |
United
| Professional | $413.99 | $413.99 | $413.99 |