Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $122.27 / $122.27 / $122.27	Facility		$122.27	$122.27	$122.27
Aetna Facility/Professional Professional Modifier Low / Median / High Price $111.15 / $122.27 / $133.38	Professional		$111.15	$122.27	$133.38
Asuris Northwest Health Facility/Professional Facility Modifier Low / Median / High Price $111.15 / $571.92 / $1,606.18	Facility		$111.15	$571.92	$1,606.18
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $111.15 / $111.15 / $1,606.18	Professional		$111.15	$111.15	$1,606.18
Cigna Facility/Professional Facility Modifier Low / Median / High Price $104.86 / $104.86 / $664.84	Facility		$104.86	$104.86	$664.84
Cigna Facility/Professional Professional Modifier Low / Median / High Price $111.15 / $111.15 / $136.32	Professional		$111.15	$111.15	$136.32
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $111.15 / $111.15 / $150.05	Facility		$111.15	$111.15	$150.05
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $111.15 / $111.15 / $150.05	Professional		$111.15	$111.15	$150.05
Molina Facility/Professional Professional Modifier Low / Median / High Price $50.00 / $75.00 / $75.00	Professional		$50.00	$75.00	$75.00
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $111.15 / $130.26 / $273.20	Facility		$111.15	$130.26	$273.20
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $384.38 / $393.42 / $393.42	Facility		$384.38	$393.42	$393.42
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $384.38 / $394.68 / $668.55	Professional		$384.38	$394.68	$668.55
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $111.15 / $111.15 / $111.15	Facility		$111.15	$111.15	$111.15
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $105.59 / $111.15 / $111.15	Professional		$105.59	$111.15	$111.15
United Facility/Professional Professional Modifier Low / Median / High Price $111.15 / $111.15 / $133.38	Professional		$111.15	$111.15	$133.38
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $111.15 / $111.15 / $363.79	Professional		$111.15	$111.15	$363.79