Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $148.37 / $148.37 / $168.61	Facility		$148.37	$148.37	$168.61
Aetna Facility/Professional Professional Modifier Low / Median / High Price $134.88 / $148.37 / $168.61	Professional		$134.88	$148.37	$168.61
Asuris Northwest Health Facility/Professional Facility Modifier Low / Median / High Price $134.88 / $219.52 / $633.20	Facility		$134.88	$219.52	$633.20
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $134.88 / $134.88 / $633.20	Professional		$134.88	$134.88	$633.20
Cigna Facility/Professional Facility Modifier Low / Median / High Price $127.25 / $127.25 / $272.95	Facility		$127.25	$127.25	$272.95
Cigna Facility/Professional Professional Modifier Low / Median / High Price $134.88 / $134.88 / $165.43	Professional		$134.88	$134.88	$165.43
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $134.88 / $134.88 / $355.86	Facility		$134.88	$134.88	$355.86
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $134.88 / $134.88 / $369.90	Professional		$134.88	$134.88	$369.90
Molina Facility/Professional Professional Modifier Low / Median / High Price $30.00 / $75.00 / $75.00	Professional		$30.00	$75.00	$75.00
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $134.88 / $137.19 / $254.94	Facility		$134.88	$137.19	$254.94
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $151.53 / $151.53 / $151.53	Facility		$151.53	$151.53	$151.53
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $151.53 / $155.60 / $277.37	Professional		$151.53	$155.60	$277.37
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $134.88 / $134.88 / $134.88	Facility		$134.88	$134.88	$134.88
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $128.15 / $134.88 / $134.88	Professional		$128.15	$134.88	$134.88
United Facility/Professional Professional Modifier Low / Median / High Price $134.88 / $134.88 / $161.87	Professional		$134.88	$134.88	$161.87
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $134.88 / $134.88 / $143.41	Professional		$134.88	$134.88	$143.41