Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $136.18 / $136.18 / $136.18	Facility		$136.18	$136.18	$136.18
Aetna Facility/Professional Professional Modifier Low / Median / High Price $123.80 / $135.43 / $137.41	Professional		$123.80	$135.43	$137.41
Asuris Northwest Health Facility/Professional Facility Modifier Low / Median / High Price $123.80 / $263.50 / $562.96	Facility		$123.80	$263.50	$562.96
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $117.61 / $123.80 / $3,125.88	Professional		$117.61	$123.80	$3,125.88
Cigna Facility/Professional Facility Modifier Low / Median / High Price $116.79 / $116.79 / $256.86	Facility		$116.79	$116.79	$256.86
Cigna Facility/Professional Professional Modifier Low / Median / High Price $123.80 / $123.80 / $151.83	Professional		$123.80	$123.80	$151.83
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $123.80 / $123.80 / $167.13	Facility		$123.80	$123.80	$167.13
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $123.80 / $123.80 / $167.13	Professional		$123.80	$123.80	$167.13
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 $123.80 / $126.06 / $233.98	Facility		$123.80	$126.06	$233.98
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $150.36 / $224.10 / $224.10	Facility		$150.36	$224.10	$224.10
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $138.33 / $150.36 / $246.59	Professional		$138.33	$150.36	$246.59
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $123.80 / $123.80 / $123.80	Facility		$123.80	$123.80	$123.80
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $117.61 / $123.80 / $123.80	Professional		$117.61	$123.80	$123.80
United Facility/Professional Professional Modifier Low / Median / High Price $123.80 / $123.80 / $148.56	Professional		$123.80	$123.80	$148.56
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $123.80 / $123.80 / $127.51	Professional		$123.80	$123.80	$127.51