Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $110.20 / $177.23 / $306.54	Facility		$110.20	$177.23	$306.54
Aetna Facility/Professional Professional Modifier Low / Median / High Price $110.20 / $148.90 / $255.00	Professional		$110.20	$148.90	$255.00
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $112.38 / $150.00 / $270.38	Professional		$112.38	$150.00	$270.38
Ambetter Facility/Professional Professional Modifier 25 Low / Median / High Price $165.45 / $165.45 / $165.45	Professional	25	$165.45	$165.45	$165.45
Ambetter Facility/Professional Professional Modifier 52 Low / Median / High Price $30.26 / $30.26 / $30.26	Professional	52	$30.26	$30.26	$30.26
Asuris Northwest Health Facility/Professional Facility Modifier Low / Median / High Price $62.40 / $234.20 / $669.10	Facility		$62.40	$234.20	$669.10
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $138.74 / $226.95 / $1,204.95	Professional		$138.74	$226.95	$1,204.95
Cigna Facility/Professional Professional Modifier Low / Median / High Price $103.00 / $160.00 / $372.00	Professional		$103.00	$160.00	$372.00
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $107.35 / $149.10 / $291.56	Facility		$107.35	$149.10	$291.56
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $107.32 / $148.57 / $264.72	Professional		$107.32	$148.57	$264.72
Molina Facility/Professional Professional Modifier Low / Median / High Price $47.73 / $240.50 / $431.87	Professional		$47.73	$240.50	$431.87
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $182.49 / $283.68 / $346.39	Facility		$182.49	$283.68	$346.39
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $234.20 / $234.20 / $234.20	Facility		$234.20	$234.20	$234.20
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $204.22 / $337.70 / $445.30	Professional		$204.22	$337.70	$445.30
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $62.40 / $128.19 / $543.76	Facility		$62.40	$128.19	$543.76
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $143.91 / $203.02 / $264.14	Professional		$143.91	$203.02	$264.14
United Facility/Professional Professional Modifier Low / Median / High Price $110.00 / $205.00 / $398.26	Professional		$110.00	$205.00	$398.26
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $142.44 / $151.25 / $180.46	Professional		$142.44	$151.25	$180.46