Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $128.16 / $261.92 / $303.76	Facility		$128.16	$261.92	$303.76
Aetna Facility/Professional Professional Modifier Low / Median / High Price $110.15 / $128.16 / $303.76	Professional		$110.15	$128.16	$303.76
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $170.94 / $170.94 / $170.94	Professional		$170.94	$170.94	$170.94
Asuris Northwest Health Facility/Professional Facility Modifier Low / Median / High Price $166.31 / $395.02 / $906.14	Facility		$166.31	$395.02	$906.14
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $135.24 / $166.21 / $979.57	Professional		$135.24	$166.21	$979.57
Cigna Facility/Professional Facility Modifier Low / Median / High Price $129.63 / $129.63 / $129.63	Facility		$129.63	$129.63	$129.63
Cigna Facility/Professional Professional Modifier Low / Median / High Price $94.64 / $94.64 / $129.63	Professional		$94.64	$94.64	$129.63
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $98.40 / $189.93 / $497.81	Facility		$98.40	$189.93	$497.81
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $99.19 / $189.93 / $369.06	Professional		$99.19	$189.93	$369.06
Molina Facility/Professional Professional Modifier Low / Median / High Price $60.00 / $189.93 / $189.93	Professional		$60.00	$189.93	$189.93
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $150.76 / $185.48 / $196.70	Facility		$150.76	$185.48	$196.70
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $170.94 / $189.93 / $196.70	Professional		$170.94	$189.93	$196.70
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $166.31 / $213.30 / $370.96	Facility		$166.31	$213.30	$370.96
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $180.78 / $185.48 / $185.48	Facility		$180.78	$185.48	$185.48
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $150.88 / $161.44 / $208.92	Professional		$150.88	$161.44	$208.92
United Facility/Professional Professional Modifier Low / Median / High Price $81.63 / $93.55 / $165.45	Professional		$81.63	$93.55	$165.45
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $83.26 / $83.26 / $113.80	Professional		$83.26	$83.26	$113.80