| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Asuris Northwest Health
| Facility | $100.00 | $100.00 | $100.00 | |
Pacific Source
| Facility | $0.19 | $0.66 | $2.22 |
Drugs Requiring Specific Ident - Drugs Requiring Detailed Coding
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Asuris Northwest Health
| Facility | $100.00 | $100.00 | $100.00 | |
Pacific Source
| Facility | $0.19 | $0.66 | $2.22 |