Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $225.45 / $225.45 / $256.18	Facility		$225.45	$225.45	$256.18
Aetna Facility/Professional Professional Modifier Low / Median / High Price $204.96 / $225.45 / $245.95	Professional		$204.96	$225.45	$245.95
Asuris Northwest Health Facility/Professional Facility Modifier Low / Median / High Price $204.96 / $1,076.67 / $1,266.67	Facility		$204.96	$1,076.67	$1,266.67
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $195.06 / $204.96 / $1,778.96	Professional		$195.06	$204.96	$1,778.96
Cigna Facility/Professional Facility Modifier Low / Median / High Price $193.35 / $193.35 / $525.86	Facility		$193.35	$193.35	$525.86
Cigna Facility/Professional Professional Modifier Low / Median / High Price $204.96 / $204.96 / $251.36	Professional		$204.96	$204.96	$251.36
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $204.96 / $204.96 / $1,253.66	Facility		$204.96	$204.96	$1,253.66
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $204.96 / $204.96 / $1,277.38	Professional		$204.96	$204.96	$1,277.38
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 $204.96 / $256.20 / $705.51	Facility		$204.96	$256.20	$705.51
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $397.51 / $1,051.33 / $1,051.33	Facility		$397.51	$1,051.33	$1,051.33
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $285.70 / $322.97 / $509.30	Professional		$285.70	$322.97	$509.30
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $204.96 / $204.96 / $204.96	Facility		$204.96	$204.96	$204.96
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $194.71 / $204.96 / $204.96	Professional		$194.71	$204.96	$204.96
United Facility/Professional Professional Modifier Low / Median / High Price $204.96 / $204.96 / $245.95	Professional		$204.96	$204.96	$245.95
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $204.96 / $204.96 / $263.35	Professional		$204.96	$204.96	$263.35