Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $96.77 / $96.77 / $96.77	Facility		$96.77	$96.77	$96.77
Aetna Facility/Professional Professional Modifier Low / Median / High Price $87.98 / $90.62 / $96.77	Professional		$87.98	$90.62	$96.77
Asuris Northwest Health Facility/Professional Facility Modifier Low / Median / High Price $87.98 / $240.79 / $530.54	Facility		$87.98	$240.79	$530.54
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $87.98 / $87.98 / $578.88	Professional		$87.98	$87.98	$578.88
Cigna Facility/Professional Facility Modifier Low / Median / High Price $83.00 / $83.00 / $189.86	Facility		$83.00	$83.00	$189.86
Cigna Facility/Professional Professional Modifier Low / Median / High Price $87.98 / $87.98 / $107.90	Professional		$87.98	$87.98	$107.90
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $87.98 / $87.98 / $118.77	Facility		$87.98	$87.98	$118.77
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $87.98 / $87.98 / $118.77	Professional		$87.98	$87.98	$118.77
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 $80.48 / $87.98 / $183.00	Facility		$80.48	$87.98	$183.00
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $100.53 / $100.53 / $100.53	Facility		$100.53	$100.53	$100.53
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $100.53 / $103.22 / $184.01	Professional		$100.53	$103.22	$184.01
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $87.98 / $87.98 / $87.98	Facility		$87.98	$87.98	$87.98
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $83.58 / $87.98 / $87.98	Professional		$83.58	$87.98	$87.98
United Facility/Professional Professional Modifier Low / Median / High Price $87.98 / $87.98 / $105.58	Professional		$87.98	$87.98	$105.58
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $87.98 / $87.98 / $95.15	Professional		$87.98	$87.98	$95.15