Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $95.56 / $143.35 / $545.89	Facility		$95.56	$143.35	$545.89
Aetna Facility/Professional Professional Modifier Low / Median / High Price $58.45 / $91.21 / $267.75	Professional		$58.45	$91.21	$267.75
Aetna Facility/Professional Professional Modifier 25 Low / Median / High Price $119.16 / $119.16 / $119.16	Professional	25	$119.16	$119.16	$119.16
Aetna Facility/Professional Professional Modifier CQ Low / Median / High Price $57.12 / $57.12 / $57.12	Professional	CQ	$57.12	$57.12	$57.12
Asuris Northwest Health Facility/Professional Facility Modifier Low / Median / High Price $129.26 / $200.40 / $458.69	Facility		$129.26	$200.40	$458.69
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $92.90 / $156.60 / $842.25	Professional		$92.90	$156.60	$842.25
Cigna Facility/Professional Facility Modifier Low / Median / High Price $90.00 / $108.00 / $118.00	Facility		$90.00	$108.00	$118.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $71.75 / $101.29 / $248.85	Professional		$71.75	$101.29	$248.85
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $72.95 / $111.47 / $230.45	Facility		$72.95	$111.47	$230.45
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $72.95 / $111.47 / $210.43	Professional		$72.95	$111.47	$210.43
Molina Facility/Professional Professional Modifier Low / Median / High Price $27.84 / $150.94 / $267.04	Professional		$27.84	$150.94	$267.04
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $131.10 / $181.70 / $201.67	Facility		$131.10	$181.70	$201.67
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $134.09 / $180.95 / $267.41	Facility		$134.09	$180.95	$267.41
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $135.60 / $188.34 / $252.15	Professional		$135.60	$188.34	$252.15
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $125.25 / $150.30 / $217.11	Facility		$125.25	$150.30	$217.11
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $97.62 / $103.85 / $173.00	Professional		$97.62	$103.85	$173.00
United Facility/Professional Professional Modifier Low / Median / High Price $81.63 / $87.70 / $234.02	Professional		$81.63	$87.70	$234.02
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $99.98 / $110.28 / $110.28	Professional		$99.98	$110.28	$110.28