| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $18.11 | $18.11 | $18.11 | |
Asuris Northwest Health
| Professional | $126.80 | $203.55 | $374.12 | |
Cigna
| Professional | $0.02 | $0.02 | $0.02 | |
Pacific Source
| Facility | $79,999.20 | $79,999.20 | $79,999.20 | |
Wellpoint
| Professional | $263.60 | $263.60 | $263.60 |