Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $79.55 / $89.52 / $189.00	Professional		$79.55	$89.52	$189.00
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $167.95 / $167.95 / $167.95	Professional		$167.95	$167.95	$167.95
Asuris Northwest Health Facility/Professional Facility Modifier Low / Median / High Price $207.32 / $801.83 / $801.83	Facility		$207.32	$801.83	$801.83
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $20.44 / $130.27 / $206.54	Professional		$20.44	$130.27	$206.54
Cigna Facility/Professional Facility Modifier Low / Median / High Price $110.00 / $110.00 / $112.20	Facility		$110.00	$110.00	$112.20
Cigna Facility/Professional Professional Modifier Low / Median / High Price $93.50 / $93.50 / $187.50	Professional		$93.50	$93.50	$187.50
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $158.50 / $158.50 / $158.50	Facility		$158.50	$158.50	$158.50
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $158.50 / $158.50 / $158.50	Professional		$158.50	$158.50	$158.50
Molina Facility/Professional Professional Modifier Low / Median / High Price $138.51 / $169.29 / $209.73	Professional		$138.51	$169.29	$209.73
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $244.04 / $275.58 / $303.51	Facility		$244.04	$275.58	$303.51
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $249.15 / $299.26 / $303.51	Professional		$249.15	$299.26	$303.51
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $15.71 / $15.71 / $15.71	Facility		$15.71	$15.71	$15.71
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $13.08 / $130.82 / $206.54	Professional		$13.08	$130.82	$206.54
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $16.79 / $16.79 / $20.44	Professional		$16.79	$16.79	$20.44
United Facility/Professional Professional Modifier Low / Median / High Price $73.62 / $103.71 / $128.84	Professional		$73.62	$103.71	$128.84
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $177.39 / $177.39 / $177.39	Professional		$177.39	$177.39	$177.39