| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $44.98 | $44.98 | $44.98 | |
Asuris Northwest Health
| Facility | $80.00 | $80.00 | $165.97 | |
Asuris Northwest Health
| Professional | $130.00 | $130.00 | $130.00 | |
Cigna
| Professional | $253.69 | $253.69 | $253.69 | |
Pacific Source
| Facility | $27.99 | $27.99 | $79,999.20 | |
United
| Professional | $27.05 | $27.73 | $29.85 |