Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $13.26 / $13.26 / $13.26	Facility		$13.26	$13.26	$13.26
Aetna Facility/Professional Professional Modifier Low / Median / High Price $12.48 / $13.26 / $13.26	Professional		$12.48	$13.26	$13.26
Asuris Northwest Health Facility/Professional Facility Modifier Low / Median / High Price $12.95 / $80.00 / $552.50	Facility		$12.95	$80.00	$552.50
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $13.26 / $1,391.41 / $1,391.41	Professional		$13.26	$1,391.41	$1,391.41
Cigna Facility/Professional Facility Modifier Low / Median / High Price $13.26 / $13.26 / $26.52	Facility		$13.26	$13.26	$26.52
Cigna Facility/Professional Professional Modifier Low / Median / High Price $13.26 / $13.26 / $13.26	Professional		$13.26	$13.26	$13.26
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $47.45 / $65.51 / $118.95	Facility		$47.45	$65.51	$118.95
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $1,218.21 / $1,218.21 / $1,218.21	Professional		$1,218.21	$1,218.21	$1,218.21
Molina Facility/Professional Professional Modifier Low / Median / High Price $45.00 / $50.00 / $50.00	Professional		$45.00	$50.00	$50.00
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $21.45 / $25.76 / $744.37	Facility		$21.45	$25.76	$744.37
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $12.95 / $12.95 / $13.26	Facility		$12.95	$12.95	$13.26
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $12.01 / $13.26 / $14.04	Professional		$12.01	$13.26	$14.04
United Facility/Professional Professional Modifier Low / Median / High Price $13.00 / $13.00 / $15.60	Professional		$13.00	$13.00	$15.60
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $13.65 / $13.65 / $13.65	Professional		$13.65	$13.65	$13.65