| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $7.08 | $7.08 | $7.08 | |
Aetna
| Professional | $5.01 | $7.08 | $21.88 | |
Molina
| Professional | $44.67 | $50.12 | $64.57 | |
Pacific Source
| Facility | $13.18 | $18.20 | $18.62 | |
Premera BCBS
| Professional | $51.29 | $51.29 | $51.29 |