| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $190.83 | $190.83 | $190.83 | |
Asuris Northwest Health
| Facility | $55.21 | $55.21 | $55.21 | |
Pacific Source
| Facility | $79,999.20 | $79,999.20 | $79,999.20 | |
Regence BlueShield
| Facility | $43.82 | $55.21 | $354.17 |