| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $43.20 | $57.60 | $72.00 | |
Asuris Northwest Health
| Facility | $100.00 | $100.00 | $100.00 | |
Asuris Northwest Health
| Professional | $56.52 | $128.00 | $64,999.35 | |
Cigna
| Professional | $10.00 | $10.00 | $58.03 | |
Molina
| Professional | $44.12 | $50.00 | $75.00 |