Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $1,527.50 / $2,713.75 / $8,953.75	Facility		$1,527.50	$2,713.75	$8,953.75
Aetna Facility/Professional Professional Modifier Low / Median / High Price $975.00 / $1,527.50 / $2,405.00	Professional		$975.00	$1,527.50	$2,405.00
Asuris Northwest Health Facility/Professional Facility Modifier Low / Median / High Price $1,706.25 / $2,666.63 / $7,718.75	Facility		$1,706.25	$2,666.63	$7,718.75
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $650.00 / $1,706.25 / $8,125.00	Professional		$650.00	$1,706.25	$8,125.00
Cigna Facility/Professional Facility Modifier Low / Median / High Price $1,690.00 / $3,327.19 / $4,225.00	Facility		$1,690.00	$3,327.19	$4,225.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,007.76 / $1,867.59 / $2,334.48	Professional		$1,007.76	$1,867.59	$2,334.48
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $1,603.63 / $2,031.25 / $4,638.62	Facility		$1,603.63	$2,031.25	$4,638.62
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $1,625.00 / $2,388.75 / $4,496.45	Professional		$1,625.00	$2,388.75	$4,496.45
Molina Facility/Professional Professional Modifier Low / Median / High Price $75.00 / $75.00 / $75.00	Professional		$75.00	$75.00	$75.00
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $1,625.00 / $1,625.00 / $3,412.50	Facility		$1,625.00	$1,625.00	$3,412.50
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $1,625.00 / $2,437.50 / $4,468.75	Facility		$1,625.00	$2,437.50	$4,468.75
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $1,462.50 / $1,950.00 / $2,307.50	Professional		$1,462.50	$1,950.00	$2,307.50
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $1,706.25 / $2,666.63 / $4,468.75	Facility		$1,706.25	$2,666.63	$4,468.75
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $1,471.18 / $2,858.41 / $3,979.85	Professional		$1,471.18	$2,858.41	$3,979.85
United Facility/Professional Professional Modifier Low / Median / High Price $682.50 / $682.50 / $1,820.00	Professional		$682.50	$682.50	$1,820.00
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $731.25 / $731.25 / $841.75	Professional		$731.25	$731.25	$841.75