Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $117.37 / $117.37 / $117.37	Facility		$117.37	$117.37	$117.37
Aetna Facility/Professional Professional Modifier Low / Median / High Price $106.70 / $107.77 / $133.38	Professional		$106.70	$107.77	$133.38
Asuris Northwest Health Facility/Professional Facility Modifier Low / Median / High Price $122.80 / $198.65 / $604.19	Facility		$122.80	$198.65	$604.19
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $98.40 / $106.70 / $1,448.75	Professional		$98.40	$106.70	$1,448.75
Cigna Facility/Professional Facility Modifier Low / Median / High Price $75.00 / $100.66 / $106.70	Facility		$75.00	$100.66	$106.70
Cigna Facility/Professional Professional Modifier Low / Median / High Price $106.70 / $106.70 / $130.86	Professional		$106.70	$106.70	$130.86
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $106.70 / $144.04 / $307.00	Facility		$106.70	$144.04	$307.00
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $106.70 / $157.44 / $307.00	Professional		$106.70	$157.44	$307.00
Molina Facility/Professional Professional Modifier Low / Median / High Price $37.50 / $75.00 / $106.70	Professional		$37.50	$75.00	$106.70
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $89.18 / $106.70 / $221.94	Facility		$89.18	$106.70	$221.94
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $122.80 / $163.86 / $468.12	Facility		$122.80	$163.86	$468.12
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $148.46 / $167.83 / $264.66	Professional		$148.46	$167.83	$264.66
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $106.70 / $106.70 / $142.84	Facility		$106.70	$106.70	$142.84
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $101.37 / $106.70 / $106.70	Professional		$101.37	$106.70	$106.70
United Facility/Professional Facility Modifier Low / Median / High Price $88.13 / $88.13 / $88.13	Facility		$88.13	$88.13	$88.13
United Facility/Professional Professional Modifier Low / Median / High Price $106.70 / $106.70 / $128.04	Professional		$106.70	$106.70	$128.04
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $106.70 / $106.70 / $136.85	Professional		$106.70	$106.70	$136.85