| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $14.14 | $14.14 | $33.28 | |
Aetna
| Professional | $13.81 | $14.14 | $14.14 | |
Asuris Northwest Health
| Professional | $1.65 | $1.65 | $100.00 | |
Molina
| Professional | $50.00 | $50.00 | $50.00 | |
Pacific Source
| Facility | $79,999.20 | $79,999.20 | $79,999.20 |