Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $151.72 / $151.72 / $151.72	Facility		$151.72	$151.72	$151.72
Aetna Facility/Professional Professional Modifier Low / Median / High Price $137.93 / $142.06 / $151.72	Professional		$137.93	$142.06	$151.72
Asuris Northwest Health Facility/Professional Facility Modifier Low / Median / High Price $137.93 / $329.31 / $1,027.45	Facility		$137.93	$329.31	$1,027.45
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $137.93 / $137.93 / $1,027.45	Professional		$137.93	$137.93	$1,027.45
Cigna Facility/Professional Facility Modifier Low / Median / High Price $130.12 / $130.12 / $256.16	Facility		$130.12	$130.12	$256.16
Cigna Facility/Professional Professional Modifier Low / Median / High Price $137.93 / $137.93 / $169.16	Professional		$137.93	$137.93	$169.16
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $137.93 / $137.93 / $186.21	Facility		$137.93	$137.93	$186.21
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $137.93 / $137.93 / $172.41	Professional		$137.93	$137.93	$172.41
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 $44.23 / $137.93 / $272.68	Facility		$44.23	$137.93	$272.68
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $245.89 / $245.89 / $245.89	Facility		$245.89	$245.89	$245.89
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $245.89 / $252.47 / $450.06	Professional		$245.89	$252.47	$450.06
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $137.93 / $137.93 / $137.93	Facility		$137.93	$137.93	$137.93
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $131.03 / $137.93 / $137.93	Professional		$131.03	$137.93	$137.93
United Facility/Professional Professional Modifier Low / Median / High Price $137.93 / $137.93 / $165.52	Professional		$137.93	$137.93	$165.52
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $137.93 / $137.93 / $232.71	Professional		$137.93	$137.93	$232.71