| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $297.06 | $297.06 | $297.06 | |
Asuris Northwest Health
| Facility | $720.30 | $720.30 | $2,401.40 | |
Pacific Source
| Facility | $272.44 | $272.44 | $79,999.20 | |
United
| Professional | $365.00 | $481.89 | $518.79 |