Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $71.43 / $289.80 / $304.33	Facility		$71.43	$289.80	$304.33
Aetna Facility/Professional Professional Modifier Low / Median / High Price $63.49 / $71.43 / $131.44	Professional		$63.49	$71.43	$131.44
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $95.26 / $95.26 / $95.26	Professional		$95.26	$95.26	$95.26
Asuris Northwest Health Facility/Professional Facility Modifier Low / Median / High Price $92.68 / $278.58 / $594.69	Facility		$92.68	$278.58	$594.69
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $77.26 / $94.46 / $880.61	Professional		$77.26	$94.46	$880.61
Cigna Facility/Professional Facility Modifier Low / Median / High Price $68.45 / $68.45 / $68.45	Facility		$68.45	$68.45	$68.45
Cigna Facility/Professional Professional Modifier Low / Median / High Price $49.98 / $49.98 / $68.45	Professional		$49.98	$49.98	$68.45
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $66.43 / $112.27 / $290.02	Facility		$66.43	$112.27	$290.02
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $66.50 / $113.06 / $225.08	Professional		$66.50	$113.06	$225.08
Molina Facility/Professional Professional Modifier Low / Median / High Price $73.02 / $81.14 / $89.25	Professional		$73.02	$81.14	$89.25
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $84.01 / $103.36 / $141.12	Facility		$84.01	$103.36	$141.12
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $84.08 / $105.84 / $141.12	Professional		$84.08	$105.84	$141.12
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $92.68 / $118.86 / $206.72	Facility		$92.68	$118.86	$206.72
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $87.86 / $87.86 / $87.86	Professional		$87.86	$87.86	$87.86
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $100.74 / $103.36 / $103.36	Facility		$100.74	$103.36	$103.36
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $84.08 / $89.96 / $116.42	Professional		$84.08	$89.96	$116.42
United Facility/Professional Facility Modifier Low / Median / High Price $141.12 / $169.34 / $169.34	Facility		$141.12	$169.34	$169.34
United Facility/Professional Professional Modifier Low / Median / High Price $48.82 / $52.80 / $100.74	Professional		$48.82	$52.80	$100.74
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $32.79 / $32.79 / $64.12	Professional		$32.79	$32.79	$64.12