Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $48.40 / $156.47 / $788.08	Facility		$48.40	$156.47	$788.08
Aetna Facility/Professional Professional Modifier Low / Median / High Price $58.69 / $66.02 / $110.83	Professional		$58.69	$66.02	$110.83
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $73.37 / $88.05 / $97.83	Professional		$73.37	$88.05	$97.83
Asuris Northwest Health Facility/Professional Facility Modifier Low / Median / High Price $85.67 / $330.85 / $556.78	Facility		$85.67	$330.85	$556.78
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $71.42 / $85.67 / $1,045.80	Professional		$71.42	$85.67	$1,045.80
Cigna Facility/Professional Facility Modifier Low / Median / High Price $72.18 / $72.18 / $72.18	Facility		$72.18	$72.18	$72.18
Cigna Facility/Professional Professional Modifier Low / Median / High Price $52.69 / $52.69 / $72.18	Professional		$52.69	$52.69	$72.18
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $61.42 / $103.81 / $268.08	Facility		$61.42	$103.81	$268.08
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $61.49 / $104.63 / $207.70	Professional		$61.49	$104.63	$207.70
Molina Facility/Professional Professional Modifier Low / Median / High Price $67.50 / $75.00 / $82.50	Professional		$67.50	$75.00	$82.50
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $77.65 / $95.54 / $130.44	Facility		$77.65	$95.54	$130.44
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $88.05 / $97.83 / $130.44	Professional		$88.05	$97.83	$130.44
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $85.67 / $109.87 / $191.08	Facility		$85.67	$109.87	$191.08
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $81.20 / $81.20 / $81.20	Professional		$81.20	$81.20	$81.20
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $93.12 / $95.54 / $95.54	Facility		$93.12	$95.54	$95.54
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $77.72 / $83.16 / $107.61	Professional		$77.72	$83.16	$107.61
United Facility/Professional Professional Modifier Low / Median / High Price $45.13 / $48.81 / $93.12	Professional		$45.13	$48.81	$93.12
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $32.79 / $32.79 / $58.96	Professional		$32.79	$32.79	$58.96