Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $70.45 / $159.94 / $166.99	Facility		$70.45	$159.94	$166.99
Aetna Facility/Professional Professional Modifier Low / Median / High Price $49.57 / $70.45 / $121.90	Professional		$49.57	$70.45	$121.90
Asuris Northwest Health Facility/Professional Facility Modifier Low / Median / High Price $91.43 / $168.27 / $456.49	Facility		$91.43	$168.27	$456.49
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $71.98 / $91.43 / $551.57	Professional		$71.98	$91.43	$551.57
Cigna Facility/Professional Facility Modifier Low / Median / High Price $53.85 / $53.85 / $53.85	Facility		$53.85	$53.85	$53.85
Cigna Facility/Professional Professional Modifier Low / Median / High Price $39.31 / $39.31 / $53.85	Professional		$39.31	$39.31	$53.85
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $68.51 / $112.12 / $298.27	Facility		$68.51	$112.12	$298.27
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $68.51 / $107.11 / $185.62	Professional		$68.51	$107.11	$185.62
Molina Facility/Professional Professional Modifier Low / Median / High Price $72.04 / $80.05 / $88.05	Professional		$72.04	$80.05	$88.05
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $84.16 / $101.96 / $104.41	Facility		$84.16	$101.96	$104.41
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $82.95 / $82.95 / $82.95	Professional		$82.95	$82.95	$82.95
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $86.67 / $91.43 / $198.82	Facility		$86.67	$91.43	$198.82
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $86.67 / $98.90 / $150.06	Professional		$86.67	$98.90	$150.06
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $99.38 / $101.96 / $101.96	Facility		$99.38	$101.96	$101.96
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $82.95 / $88.75 / $114.85	Professional		$82.95	$88.75	$114.85
United Facility/Professional Professional Modifier Low / Median / High Price $41.08 / $47.22 / $82.03	Professional		$41.08	$47.22	$82.03
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $50.59 / $88.75 / $88.75	Professional		$50.59	$88.75	$88.75