| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Asuris Northwest Health
| Facility | $100.00 | $100.00 | $100.00 | |
Asuris Northwest Health
| Professional | $2.98 | $3.33 | $3.51 | |
Pacific Source
| Facility | $79,999.20 | $79,999.20 | $79,999.20 | |
Wellpoint
| Professional | $3.51 | $3.51 | $3.51 |