| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $548.86 | $548.86 | $548.86 | |
Asuris Northwest Health
| Facility | $100.00 | $100.00 | $100.00 | |
Asuris Northwest Health
| Professional | $3,984.00 | $3,984.00 | $3,984.00 | |
Molina
| Professional | $50.00 | $50.00 | $75.00 | |
Pacific Source
| Facility | $79,999.20 | $79,999.20 | $79,999.20 | |
United
| Professional | $4,800.00 | $4,800.00 | $5,760.00 |