Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $73.38 / $83.16 / $189.99	Facility		$73.38	$83.16	$189.99
Aetna Facility/Professional Facility Modifier 25 Low / Median / High Price $199.80 / $199.80 / $199.80	Facility	25	$199.80	$199.80	$199.80
Aetna Facility/Professional Professional Modifier Low / Median / High Price $55.52 / $73.38 / $97.84	Professional		$55.52	$73.38	$97.84
Asuris Northwest Health Facility/Professional Facility Modifier Low / Median / High Price $94.68 / $151.37 / $367.85	Facility		$94.68	$151.37	$367.85
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $95.72 / $148.69 / $220.43	Professional		$95.72	$148.69	$220.43
Cigna Facility/Professional Professional Modifier Low / Median / High Price $64.31 / $146.46 / $219.09	Professional		$64.31	$146.46	$219.09
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $126.32 / $126.32 / $126.32	Facility		$126.32	$126.32	$126.32
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $126.32 / $126.32 / $126.32	Professional		$126.32	$126.32	$126.32
Molina Facility/Professional Professional Modifier Low / Median / High Price $27.61 / $145.55 / $235.55	Professional		$27.61	$145.55	$235.55
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $98.21 / $138.69 / $162.81	Facility		$98.21	$138.69	$162.81
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $94.68 / $94.68 / $105.34	Facility		$94.68	$94.68	$105.34
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $106.31 / $171.01 / $220.43	Professional		$106.31	$171.01	$220.43
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $95.72 / $159.57 / $215.18	Professional		$95.72	$159.57	$215.18
United Facility/Professional Professional Modifier Low / Median / High Price $80.50 / $95.70 / $204.94	Professional		$80.50	$95.70	$204.94