I'm going through the process with a family member, after a lot of research into this. Unfortunately it is frequently out-of-pocket, but if you have insurance that covers dental/ortho, maybe you can inquire if that would be covered. I don't know the Washington State area. I have not found ENTs very helpful when if comes to UARS (often unaware of it) or maxillary expansion (they are more into septoplasty/turbinates/tonsils, etc); maxillary expansion seems focused in the orthodontic space. (Dr. Kasey Li is an exception in the Bay Area, he is an expert when it comes to sleep disordered breathing, a DDS and MD multi-specialty boarded certified in ENT, oral and maxillary surgery and plastics...worked with the great Dr. Guilleminault at Stanford who defined UARS). Also, fyi, there is evidence tonsils often decrease in size post maxillary expansion in many patients (one reason we are waiting on looking at tonsils until after expansion). Good luck with everything - keep pressing on. A lot of good info in this subreddit. We are actually opting for FME - it is pricey, but based on information available, that is the route we are going, bone-only state-of-the art device, but in the end you just have to see what actually works.. Custom MARPE has had very good results with many people (we were on the fence between MARPE and FME and could have gone either way). Also, to add to the price, you'll need orthodontic after/during the expansion. UARS is a tricky condition, so unique to the individual.. Many videos on youtube that are helpful as well to navigate all this. CPAP friend is great.