| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $194.22 | $194.22 | $577.54 | |
Aetna
| Professional | $194.22 | $194.22 | $194.22 | |
Cigna
| Professional | $206.70 | $206.70 | $206.70 | |
Regence BlueShield
| Facility | $217.34 | $300.70 | $431.69 | |
United
| Professional | $222.30 | $234.00 | $234.00 |