| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1.00 | $1.00 | $3.02 | |
Aetna
| Professional | $1.00 | $1.00 | $2.57 | |
Molina
| Professional | $64.57 | $64.57 | $75.86 | |
Pacific Source
| Facility | $177.83 | $177.83 | $204.17 | |
Regence BlueShield
| Facility | $40.74 | $40.74 | $263.03 | |
United
| Professional | $1.51 | $1.51 | $1.51 |