Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $117.16 / $184.47 / $686.77	Facility		$117.16	$184.47	$686.77
Aetna Facility/Professional Professional Modifier Low / Median / High Price $117.16 / $117.16 / $350.00	Professional		$117.16	$117.16	$350.00
Asuris Northwest Health Facility/Professional Facility Modifier Low / Median / High Price $130.87 / $199.42 / $514.94	Facility		$130.87	$199.42	$514.94
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $93.48 / $243.65 / $934.80	Professional		$93.48	$243.65	$934.80
Cigna Facility/Professional Facility Modifier Low / Median / High Price $129.63 / $266.48 / $364.59	Facility		$129.63	$266.48	$364.59
Cigna Facility/Professional Professional Modifier Low / Median / High Price $39.94 / $131.90 / $170.20	Professional		$39.94	$131.90	$170.20
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $123.07 / $157.50 / $385.48	Facility		$123.07	$157.50	$385.48
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $124.64 / $183.22 / $344.89	Professional		$124.64	$183.22	$344.89
Molina Facility/Professional Professional Modifier Low / Median / High Price $75.00 / $75.00 / $75.00	Professional		$75.00	$75.00	$75.00
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $124.64 / $124.64 / $261.74	Facility		$124.64	$124.64	$261.74
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $124.64 / $218.12 / $373.92	Facility		$124.64	$218.12	$373.92
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $112.18 / $155.80 / $188.21	Professional		$112.18	$155.80	$188.21
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $130.87 / $204.53 / $342.76	Facility		$130.87	$204.53	$342.76
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $137.85 / $242.44 / $289.48	Professional		$137.85	$242.44	$289.48
United Facility/Professional Professional Modifier Low / Median / High Price $34.99 / $52.35 / $137.10	Professional		$34.99	$52.35	$137.10