| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Asuris Northwest Health
| Facility | $80.00 | $90.00 | $90.00 | |
Asuris Northwest Health
| Professional | $27.50 | $27.50 | $27.50 | |
Pacific Source
| Facility | $79,999.20 | $79,999.20 | $79,999.20 |