Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $549.80 / $931.80 / $1,748.27	Facility		$549.80	$931.80	$1,748.27
Aetna Facility/Professional Professional Modifier Low / Median / High Price $368.49 / $549.80 / $2,162.11	Professional		$368.49	$549.80	$2,162.11
Asuris Northwest Health Facility/Professional Facility Modifier Low / Median / High Price $614.15 / $1,169.80 / $2,828.48	Facility		$614.15	$1,169.80	$2,828.48
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $348.90 / $713.49 / $2,924.50	Professional		$348.90	$713.49	$2,924.50
Cigna Facility/Professional Facility Modifier Low / Median / High Price $398.71 / $1,060.78 / $2,079.06	Facility		$398.71	$1,060.78	$2,079.06
Cigna Facility/Professional Professional Modifier Low / Median / High Price $373.55 / $671.95 / $848.32	Professional		$373.55	$671.95	$848.32
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $584.90 / $860.68 / $2,001.56	Facility		$584.90	$860.68	$2,001.56
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $584.90 / $1,034.55 / $1,808.88	Professional		$584.90	$1,034.55	$1,808.88
Molina Facility/Professional Professional Modifier Low / Median / High Price $75.00 / $416.44 / $451.40	Professional		$75.00	$416.44	$451.40
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $584.90 / $584.90 / $1,291.17	Facility		$584.90	$584.90	$1,291.17
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $584.90 / $877.35 / $1,608.48	Facility		$584.90	$877.35	$1,608.48
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $526.41 / $701.88 / $830.56	Professional		$526.41	$701.88	$830.56
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $672.64 / $965.09 / $1,608.48	Facility		$672.64	$965.09	$1,608.48
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $529.44 / $1,028.72 / $1,432.58	Professional		$529.44	$1,028.72	$1,432.58
United Facility/Professional Professional Modifier Low / Median / High Price $245.66 / $245.66 / $655.09	Professional		$245.66	$245.66	$655.09
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $263.20 / $263.20 / $302.98	Professional		$263.20	$263.20	$302.98