Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $199.96 / $455.70 / $13,750.00	Facility		$199.96	$455.70	$13,750.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $105.07 / $173.98 / $442.88	Professional		$105.07	$173.98	$442.88
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $291.14 / $291.14 / $291.14	Professional		$291.14	$291.14	$291.14
Asuris Northwest Health Facility/Professional Facility Modifier Low / Median / High Price $258.20 / $1,559.22 / $11,500.00	Facility		$258.20	$1,559.22	$11,500.00
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $172.27 / $362.50 / $1,394.64	Professional		$172.27	$362.50	$1,394.64
Cigna Facility/Professional Facility Modifier Low / Median / High Price $183.49 / $466.83 / $636.00	Facility		$183.49	$466.83	$636.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $137.54 / $268.58 / $531.89	Professional		$137.54	$268.58	$531.89
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $141.04 / $251.97 / $461.90	Facility		$141.04	$251.97	$461.90
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $136.11 / $242.17 / $419.04	Professional		$136.11	$242.17	$419.04
Molina Facility/Professional Professional Modifier Low / Median / High Price $40.85 / $243.92 / $429.64	Professional		$40.85	$243.92	$429.64
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $205.40 / $326.29 / $378.55	Facility		$205.40	$326.29	$378.55
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $143.15 / $255.04 / $258.20	Facility		$143.15	$255.04	$258.20
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $178.29 / $290.75 / $488.25	Professional		$178.29	$290.75	$488.25
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $1,120.58 / $1,558.33 / $2,982.61	Facility		$1,120.58	$1,558.33	$2,982.61
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $179.11 / $291.02 / $429.12	Professional		$179.11	$291.02	$429.12
United Facility/Professional Facility Modifier Low / Median / High Price $125.00 / $497.00 / $5,793.00	Facility		$125.00	$497.00	$5,793.00
United Facility/Professional Professional Modifier Low / Median / High Price $188.99 / $305.32 / $546.47	Professional		$188.99	$305.32	$546.47
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $118.38 / $154.32 / $210.33	Professional		$118.38	$154.32	$210.33