| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $12.79 | $12.79 | $28.80 | |
Aetna
| Professional | $11.95 | $12.79 | $12.79 | |
Asuris Northwest Health
| Facility | $11.65 | $14.24 | $30.76 | |
Asuris Northwest Health
| Professional | $11.96 | $11.96 | $14.40 | |
Pacific Source
| Facility | $79,999.20 | $79,999.20 | $79,999.20 | |
Regence BlueShield
| Facility | $11.86 | $13.98 | $25.54 | |
United
| Professional | $14.40 | $14.40 | $16.13 |