Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $71.40 / $123.52 / $169.22	Facility		$71.40	$123.52	$169.22
Aetna Facility/Professional Professional Modifier Low / Median / High Price $68.04 / $71.40 / $83.66	Professional		$68.04	$71.40	$83.66
Asuris Northwest Health Facility/Professional Facility Modifier Low / Median / High Price $79.80 / $94.12 / $327.45	Facility		$79.80	$94.12	$327.45
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $79.80 / $79.80 / $617.10	Professional		$79.80	$79.80	$617.10
Cigna Facility/Professional Facility Modifier Low / Median / High Price $71.40 / $71.40 / $142.80	Facility		$71.40	$71.40	$142.80
Cigna Facility/Professional Professional Modifier Low / Median / High Price $71.40 / $71.40 / $71.40	Professional		$71.40	$71.40	$71.40
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $67.27 / $158.05 / $194.58	Facility		$67.27	$158.05	$194.58
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $67.27 / $158.05 / $198.59	Professional		$67.27	$158.05	$198.59
Molina Facility/Professional Professional Modifier Low / Median / High Price $75.00 / $75.00 / $87.78	Professional		$75.00	$75.00	$87.78
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $79.80 / $79.80 / $134.00	Facility		$79.80	$79.80	$134.00
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $79.80 / $79.80 / $79.80	Facility		$79.80	$79.80	$79.80
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $79.80 / $79.80 / $79.80	Professional		$79.80	$79.80	$79.80
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $79.80 / $79.80 / $79.80	Facility		$79.80	$79.80	$79.80
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $75.81 / $79.80 / $79.80	Professional		$75.81	$79.80	$79.80
United Facility/Professional Professional Modifier Low / Median / High Price $79.80 / $79.80 / $95.76	Professional		$79.80	$79.80	$95.76