| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $130.66 | $130.66 | $130.66 | |
Aetna
| Professional | $130.66 | $130.66 | $338.02 | |
Regence BlueShield
| Facility | $444.26 | $575.98 | $593.78 | |
United
| Professional | $237.73 | $346.73 | $498.75 |