| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $124.50 | $124.50 | $124.50 | |
Aetna
| Professional | $124.50 | $124.50 | $124.50 | |
Cigna
| Professional | $127.50 | $127.50 | $127.50 | |
Regence BlueShield
| Facility | $213.97 | $274.73 | $463.42 | |
United
| Professional | $118.75 | $125.00 | $125.00 |