Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $319.29 / $2,383.16 / $13,809.00	Facility		$319.29	$2,383.16	$13,809.00
Aetna Facility/Professional Facility Modifier 50 Low / Median / High Price $2,614.50 / $2,614.50 / $2,614.50	Facility	50	$2,614.50	$2,614.50	$2,614.50
Aetna Facility/Professional Professional Modifier Low / Median / High Price $241.91 / $975.03 / $2,143.94	Professional		$241.91	$975.03	$2,143.94
Asuris Northwest Health Facility/Professional Facility Modifier Low / Median / High Price $2,182.75 / $2,182.75 / $8,980.00	Facility		$2,182.75	$2,182.75	$8,980.00
Asuris Northwest Health Facility/Professional Facility Modifier 50 Low / Median / High Price $5,820.27 / $5,820.27 / $5,820.27	Facility	50	$5,820.27	$5,820.27	$5,820.27
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $409.39 / $2,224.77 / $8,961.76	Professional		$409.39	$2,224.77	$8,961.76
Cigna Facility/Professional Professional Modifier Low / Median / High Price $298.56 / $757.25 / $3,541.56	Professional		$298.56	$757.25	$3,541.56
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $322.94 / $954.18 / $3,101.39	Facility		$322.94	$954.18	$3,101.39
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $326.88 / $954.18 / $3,267.93	Professional		$326.88	$954.18	$3,267.93
Molina Facility/Professional Professional Modifier Low / Median / High Price $324.09 / $1,933.10 / $3,255.52	Professional		$324.09	$1,933.10	$3,255.52
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $491.04 / $2,321.90 / $2,558.73	Facility		$491.04	$2,321.90	$2,558.73
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $1,668.05 / $1,668.05 / $1,741.79	Facility		$1,668.05	$1,668.05	$1,741.79
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $410.67 / $1,661.12 / $3,310.92	Professional		$410.67	$1,661.12	$3,310.92
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $416.93 / $857.45 / $2,845.30	Professional		$416.93	$857.45	$2,845.30
United Facility/Professional Facility Modifier Low / Median / High Price $414.00 / $666.00 / $6,216.00	Facility		$414.00	$666.00	$6,216.00
United Facility/Professional Professional Modifier Low / Median / High Price $1,439.94 / $2,291.40 / $3,763.44	Professional		$1,439.94	$2,291.40	$3,763.44
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $237.00 / $237.00 / $1,359.32	Professional		$237.00	$237.00	$1,359.32