Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $161.50 / $161.50 / $161.50	Facility		$161.50	$161.50	$161.50
Aetna Facility/Professional Professional Modifier Low / Median / High Price $152.00 / $161.50 / $161.50	Professional		$152.00	$161.50	$161.50
Asuris Northwest Health Facility/Professional Facility Modifier Low / Median / High Price $157.69 / $180.50 / $712.50	Facility		$157.69	$180.50	$712.50
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $156.06 / $722.00 / $855.00	Professional		$156.06	$722.00	$855.00
Cigna Facility/Professional Facility Modifier Low / Median / High Price $161.50 / $161.50 / $323.00	Facility		$161.50	$161.50	$323.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $161.50 / $161.50 / $161.50	Professional		$161.50	$161.50	$161.50
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $165.46 / $165.46 / $165.46	Professional		$165.46	$165.46	$165.46
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 $65.92 / $65.92 / $79,999.20	Facility		$65.92	$65.92	$79,999.20
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $157.69 / $157.69 / $161.50	Facility		$157.69	$157.69	$161.50
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $146.30 / $161.50 / $171.00	Professional		$146.30	$161.50	$171.00
United Facility/Professional Professional Modifier Low / Median / High Price $167.51 / $167.51 / $201.01	Professional		$167.51	$167.51	$201.01
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $65.92 / $65.92 / $65.92	Professional		$65.92	$65.92	$65.92