| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | 26 | $101.50 | $112.46 | $226.66 |
Kaiser Permanente
| Professional | 26 | $45.43 | $104.76 | $108.37 |
Pacific Source
| Facility | 26 | $68.31 | $88.31 | $94.47 |
Regence BlueShield
| Facility | 26 | $4,053.27 | $4,053.27 | $4,053.27 |