Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $102.85 / $102.85 / $102.85	Facility		$102.85	$102.85	$102.85
Aetna Facility/Professional Professional Modifier Low / Median / High Price $96.80 / $102.85 / $102.85	Professional		$96.80	$102.85	$102.85
Asuris Northwest Health Facility/Professional Facility Modifier Low / Median / High Price $30.23 / $85.32 / $453.75	Facility		$30.23	$85.32	$453.75
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $102.85 / $459.80 / $544.50	Professional		$102.85	$459.80	$544.50
Cigna Facility/Professional Facility Modifier Low / Median / High Price $102.85 / $102.85 / $205.70	Facility		$102.85	$102.85	$205.70
Cigna Facility/Professional Professional Modifier Low / Median / High Price $102.85 / $102.85 / $102.85	Professional		$102.85	$102.85	$102.85
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $118.33 / $118.33 / $118.33	Facility		$118.33	$118.33	$118.33
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $132.66 / $132.66 / $132.66	Professional		$132.66	$132.66	$132.66
Molina Facility/Professional Professional Modifier Low / Median / High Price $50.00 / $50.00 / $75.00	Professional		$50.00	$50.00	$75.00
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $79,999.20 / $79,999.20 / $79,999.20	Facility		$79,999.20	$79,999.20	$79,999.20
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $29.00 / $76.18 / $102.85	Facility		$29.00	$76.18	$102.85
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $93.17 / $102.85 / $108.90	Professional		$93.17	$102.85	$108.90
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $74.90 / $74.90 / $82.39	Facility		$74.90	$74.90	$82.39
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $49.10 / $49.10 / $86.42	Professional		$49.10	$49.10	$86.42
United Facility/Professional Professional Modifier Low / Median / High Price $110.00 / $110.00 / $132.00	Professional		$110.00	$110.00	$132.00
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $110.00 / $110.00 / $110.00	Professional		$110.00	$110.00	$110.00