Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $78.25 / $177.63 / $185.45	Facility		$78.25	$177.63	$185.45
Aetna Facility/Professional Professional Modifier Low / Median / High Price $69.55 / $78.25 / $185.45	Professional		$69.55	$78.25	$185.45
Asuris Northwest Health Facility/Professional Facility Modifier Low / Median / High Price $101.52 / $252.55 / $608.40	Facility		$101.52	$252.55	$608.40
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $84.64 / $106.34 / $798.48	Professional		$84.64	$106.34	$798.48
Cigna Facility/Professional Facility Modifier Low / Median / High Price $75.81 / $75.81 / $75.81	Facility		$75.81	$75.81	$75.81
Cigna Facility/Professional Professional Modifier Low / Median / High Price $55.35 / $55.35 / $75.81	Professional		$55.35	$55.35	$75.81
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $76.44 / $124.03 / $317.70	Facility		$76.44	$124.03	$317.70
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $76.80 / $124.80 / $245.76	Professional		$76.80	$124.80	$245.76
Molina Facility/Professional Professional Modifier Low / Median / High Price $80.00 / $88.89 / $97.77	Professional		$80.00	$88.89	$97.77
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $92.03 / $113.23 / $124.71	Facility		$92.03	$113.23	$124.71
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $92.11 / $115.94 / $124.71	Professional		$92.11	$115.94	$124.71
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $101.52 / $130.21 / $226.46	Facility		$101.52	$130.21	$226.46
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $96.25 / $96.25 / $96.25	Professional		$96.25	$96.25	$96.25
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $110.36 / $113.23 / $113.23	Facility		$110.36	$113.23	$113.23
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $92.11 / $98.55 / $127.53	Professional		$92.11	$98.55	$127.53
United Facility/Professional Facility Modifier Low / Median / High Price $88.00 / $88.00 / $88.00	Facility		$88.00	$88.00	$88.00
United Facility/Professional Professional Modifier Low / Median / High Price $53.48 / $57.93 / $110.36	Professional		$53.48	$57.93	$110.36
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $52.04 / $52.04 / $70.61	Professional		$52.04	$52.04	$70.61