| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $30.60 | $30.60 | $30.60 | |
Aetna
| Professional | $30.60 | $30.60 | $30.60 | |
Asuris Northwest Health
| Facility | $155.82 | $159.00 | $159.00 | |
Pacific Source
| Facility | $79,999.20 | $79,999.20 | $79,999.20 |