Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $98.72 / $98.72 / $98.72	Facility		$98.72	$98.72	$98.72
Aetna Facility/Professional Professional Modifier Low / Median / High Price $89.75 / $92.44 / $98.72	Professional		$89.75	$92.44	$98.72
Asuris Northwest Health Facility/Professional Facility Modifier Low / Median / High Price $89.75 / $1,417.80 / $1,668.00	Facility		$89.75	$1,417.80	$1,668.00
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $80.78 / $89.75 / $1,668.00	Professional		$80.78	$89.75	$1,668.00
Cigna Facility/Professional Facility Modifier Low / Median / High Price $84.67 / $84.67 / $143.63	Facility		$84.67	$84.67	$143.63
Cigna Facility/Professional Professional Modifier Low / Median / High Price $89.75 / $89.75 / $110.07	Professional		$89.75	$89.75	$110.07
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $89.75 / $89.75 / $121.16	Facility		$89.75	$89.75	$121.16
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $89.75 / $89.75 / $121.16	Professional		$89.75	$89.75	$121.16
Molina Facility/Professional Professional Modifier Low / Median / High Price $30.00 / $60.00 / $60.00	Professional		$30.00	$60.00	$60.00
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $76.47 / $89.75 / $169.63	Facility		$76.47	$89.75	$169.63
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $110.82 / $1,384.44 / $1,384.44	Facility		$110.82	$1,384.44	$1,384.44
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $79.65 / $90.04 / $141.97	Professional		$79.65	$90.04	$141.97
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $89.75 / $89.75 / $89.75	Facility		$89.75	$89.75	$89.75
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $85.26 / $89.75 / $89.75	Professional		$85.26	$89.75	$89.75
United Facility/Professional Professional Modifier Low / Median / High Price $89.75 / $89.75 / $107.70	Professional		$89.75	$89.75	$107.70
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $73.42 / $89.75 / $89.75	Professional		$73.42	$89.75	$89.75