Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $82.79 / $187.93 / $196.21	Facility		$82.79	$187.93	$196.21
Aetna Facility/Professional Professional Modifier Low / Median / High Price $58.73 / $82.79 / $196.21	Professional		$58.73	$82.79	$196.21
Asuris Northwest Health Facility/Professional Facility Modifier Low / Median / High Price $111.55 / $253.08 / $629.92	Facility		$111.55	$253.08	$629.92
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $91.93 / $114.69 / $751.68	Professional		$91.93	$114.69	$751.68
Cigna Facility/Professional Facility Modifier Low / Median / High Price $97.44 / $97.44 / $97.44	Facility		$97.44	$97.44	$97.44
Cigna Facility/Professional Professional Modifier Low / Median / High Price $71.13 / $71.13 / $97.44	Professional		$71.13	$71.13	$97.44
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $73.70 / $127.39 / $335.62	Facility		$73.70	$127.39	$335.62
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $73.79 / $129.55 / $249.07	Professional		$73.79	$129.55	$249.07
Molina Facility/Professional Professional Modifier Low / Median / High Price $87.89 / $97.66 / $107.42	Professional		$87.89	$97.66	$107.42
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $101.11 / $117.45 / $127.39	Facility		$101.11	$117.45	$127.39
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $114.65 / $127.39 / $129.19	Professional		$114.65	$127.39	$129.19
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $111.55 / $143.06 / $248.80	Facility		$111.55	$143.06	$248.80
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $121.25 / $124.40 / $124.40	Facility		$121.25	$124.40	$124.40
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $101.20 / $108.28 / $140.13	Professional		$101.20	$108.28	$140.13
United Facility/Professional Facility Modifier Low / Median / High Price $156.60 / $187.92 / $187.92	Facility		$156.60	$187.92	$187.92
United Facility/Professional Professional Modifier Low / Median / High Price $58.60 / $87.89 / $111.79	Professional		$58.60	$87.89	$111.79
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $54.12 / $54.12 / $71.42	Professional		$54.12	$54.12	$71.42