Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $102.80 / $102.80 / $102.80	Facility		$102.80	$102.80	$102.80
Aetna Facility/Professional Professional Modifier Low / Median / High Price $96.75 / $102.80 / $102.80	Professional		$96.75	$102.80	$102.80
Asuris Northwest Health Facility/Professional Facility Modifier Low / Median / High Price $100.38 / $120.94 / $453.53	Facility		$100.38	$120.94	$453.53
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $102.80 / $459.57 / $544.23	Professional		$102.80	$459.57	$544.23
Cigna Facility/Professional Facility Modifier Low / Median / High Price $102.80 / $102.80 / $411.20	Facility		$102.80	$102.80	$411.20
Cigna Facility/Professional Professional Modifier Low / Median / High Price $102.80 / $102.80 / $102.80	Professional		$102.80	$102.80	$102.80
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $107.15 / $107.15 / $107.15	Professional		$107.15	$107.15	$107.15
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 $79,999.20 / $79,999.20 / $79,999.20	Facility		$79,999.20	$79,999.20	$79,999.20
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $100.38 / $100.38 / $102.80	Facility		$100.38	$100.38	$102.80
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $93.12 / $102.80 / $108.85	Professional		$93.12	$102.80	$108.85
United Facility/Professional Professional Modifier Low / Median / High Price $100.78 / $100.78 / $120.94	Professional		$100.78	$100.78	$120.94
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $102.80 / $102.80 / $102.80	Professional		$102.80	$102.80	$102.80