| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $776.12 | $776.12 | $776.12 | |
Aetna
| Professional | $776.12 | $776.12 | $776.12 | |
Cigna
| Professional | $794.83 | $794.83 | $794.83 | |
Regence BlueShield
| Facility | $1,161.74 | $1,551.80 | $2,227.84 |