| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | 26 | $549.77 | $655.85 | $823.52 |
Kaiser Permanente
| Professional | 26 | $535.22 | $756.72 | $861.42 |
Pacific Source
| Facility | 26 | $497.10 | $652.00 | $696.32 |
Regence BlueShield
| Facility | 26 | $9,482.39 | $9,482.39 | $9,482.39 |