| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $138.04 | $173.78 | $309.03 | |
Kaiser Permanente
| Facility | $117.49 | $199.53 | $275.42 | |
Pacific Source
| Facility | $158.49 | $194.98 | $251.19 | |
Premera BCBS
| Facility | $125.89 | $125.89 | $169.82 |