| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Asuris Northwest Health
| Facility | $67.23 | $90.00 | $100.00 | |
Asuris Northwest Health
| Professional | $152.16 | $152.16 | $152.16 | |
Cigna
| Professional | $48.83 | $103.46 | $131.01 | |
Pacific Source
| Facility | $36.26 | $48.10 | $53.04 |