| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $8.00 | $8.00 | $8.00 | |
Asuris Northwest Health
| Facility | $100.00 | $100.00 | $100.00 | |
Asuris Northwest Health
| Professional | $2.02 | $3.59 | $729.62 | |
Cigna
| Professional | $21.00 | $21.00 | $21.00 | |
Molina
| Professional | $50.00 | $50.00 | $75.00 | |
Pacific Source
| Facility | $79,999.20 | $79,999.20 | $79,999.20 | |
Wellpoint
| Professional | $729.62 | $729.62 | $729.62 |