| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $297.44 | $297.44 | $297.44 | |
Aetna
| Professional | $297.44 | $297.44 | $297.44 | |
Regence BlueShield
| Facility | $360.34 | $412.23 | $412.79 | |
United
| Professional | $222.87 | $283.27 | $347.39 |