| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $213.88 | $213.88 | $213.88 | |
Asuris Northwest Health
| Facility | $177.00 | $177.00 | $334.01 | |
Cigna
| Facility | $68.25 | $123.98 | $229.03 | |
Pacific Source
| Facility | $35.00 | $158.00 | $212.00 | |
Premera BCBS
| Facility | $177.00 | $177.00 | $317.31 |