Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $58.03 / $97.70 / $101.61	Facility		$58.03	$97.70	$101.61
Aetna Facility/Professional Professional Modifier Low / Median / High Price $52.75 / $57.50 / $65.94	Professional		$52.75	$57.50	$65.94
Asuris Northwest Health Facility/Professional Facility Modifier Low / Median / High Price $20.39 / $48.60 / $213.92	Facility		$20.39	$48.60	$213.92
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $48.85 / $52.75 / $213.92	Professional		$48.85	$52.75	$213.92
Cigna Facility/Professional Facility Modifier Low / Median / High Price $49.77 / $49.77 / $103.58	Facility		$49.77	$49.77	$103.58
Cigna Facility/Professional Professional Modifier Low / Median / High Price $52.75 / $52.75 / $64.70	Professional		$52.75	$52.75	$64.70
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $39.68 / $58.38 / $115.04	Facility		$39.68	$58.38	$115.04
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $44.20 / $65.94 / $119.19	Professional		$44.20	$65.94	$119.19
Molina Facility/Professional Professional Modifier Low / Median / High Price $39.55 / $52.75 / $75.00	Professional		$39.55	$52.75	$75.00
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $46.29 / $52.75 / $99.70	Facility		$46.29	$52.75	$99.70
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $19.57 / $25.35 / $51.20	Facility		$19.57	$25.35	$51.20
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $51.20 / $52.57 / $93.71	Professional		$51.20	$52.57	$93.71
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $23.35 / $52.75 / $52.75	Facility		$23.35	$52.75	$52.75
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $50.11 / $52.75 / $52.75	Professional		$50.11	$52.75	$52.75
United Facility/Professional Professional Modifier Low / Median / High Price $52.75 / $52.75 / $63.30	Professional		$52.75	$52.75	$63.30
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $48.45 / $52.75 / $52.75	Professional		$48.45	$52.75	$52.75