Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $472.20 / $481.30 / $754.83	Professional		$472.20	$481.30	$754.83
Asuris Northwest Health Facility/Professional Facility Modifier Low / Median / High Price $100.00 / $4,986.09 / $4,986.09	Facility		$100.00	$4,986.09	$4,986.09
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $80.73 / $723.07 / $1,173.22	Professional		$80.73	$723.07	$1,173.22
Cigna Facility/Professional Facility Modifier Low / Median / High Price $458.33 / $458.33 / $458.33	Facility		$458.33	$458.33	$458.33
Cigna Facility/Professional Professional Modifier Low / Median / High Price $82.44 / $458.32 / $549.99	Professional		$82.44	$458.32	$549.99
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $962.60 / $962.60 / $962.60	Facility		$962.60	$962.60	$962.60
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $962.60 / $962.60 / $962.60	Professional		$962.60	$962.60	$962.60
Molina Facility/Professional Professional Modifier Low / Median / High Price $677.52 / $752.80 / $828.08	Professional		$677.52	$752.80	$828.08
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $798.64 / $1,713.75 / $1,887.39	Facility		$798.64	$1,713.75	$1,887.39
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $1,549.35 / $1,860.97 / $1,887.39	Professional		$1,549.35	$1,860.97	$1,887.39
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $83.87 / $83.87 / $83.87	Facility		$83.87	$83.87	$83.87
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $79.44 / $794.41 / $1,258.34	Professional		$79.44	$794.41	$1,258.34
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $66.31 / $66.31 / $80.73	Professional		$66.31	$66.31	$80.73
United Facility/Professional Professional Modifier Low / Median / High Price $470.76 / $580.79 / $899.10	Professional		$470.76	$580.79	$899.10
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $880.63 / $880.63 / $880.63	Professional		$880.63	$880.63	$880.63