| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $21.24 | $21.24 | $21.24 | |
Asuris Northwest Health
| Facility | $18.22 | $100.00 | $100.00 | |
Asuris Northwest Health
| Professional | $15.18 | $20.23 | $134.00 | |
Cigna
| Professional | $228.00 | $228.00 | $228.00 | |
Molina
| Professional | $75.00 | $75.00 | $75.00 | |
Pacific Source
| Facility | $79,999.20 | $79,999.20 | $79,999.20 |