| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $29.08 | $37.40 | $37.40 | |
Asuris Northwest Health
| Facility | $75.00 | $75.00 | $155.77 | |
Asuris Northwest Health
| Professional | $75.00 | $75.00 | $75.00 | |
Cigna
| Professional | $24.20 | $24.20 | $24.20 | |
Pacific Source
| Facility | $48.40 | $58.13 | $58.96 | |
United
| Professional | $36.96 | $37.84 | $45.73 |