Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $1,275.00 / $1,275.00 / $1,275.00	Facility		$1,275.00	$1,275.00	$1,275.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,200.00 / $1,275.00 / $1,275.00	Professional		$1,200.00	$1,275.00	$1,275.00
Asuris Northwest Health Facility/Professional Facility Modifier Low / Median / High Price $1,245.00 / $1,878.72 / $5,130.00	Facility		$1,245.00	$1,878.72	$5,130.00
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $1,020.00 / $5,250.00 / $6,156.00	Professional		$1,020.00	$5,250.00	$6,156.00
Cigna Facility/Professional Facility Modifier Low / Median / High Price $1,275.00 / $1,275.00 / $2,550.00	Facility		$1,275.00	$1,275.00	$2,550.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,275.00 / $1,275.00 / $1,275.00	Professional		$1,275.00	$1,275.00	$1,275.00
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $47.45 / $65.51 / $118.95	Facility		$47.45	$65.51	$118.95
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $3,518.64 / $3,518.64 / $3,518.64	Professional		$3,518.64	$3,518.64	$3,518.64
Molina Facility/Professional Professional Modifier Low / Median / High Price $45.00 / $50.00 / $50.00	Professional		$45.00	$50.00	$50.00
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $1,764.95 / $2,150.03 / $2,150.03	Facility		$1,764.95	$2,150.03	$2,150.03
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $1,245.00 / $1,245.00 / $1,275.00	Facility		$1,245.00	$1,245.00	$1,275.00
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $1,155.00 / $1,275.00 / $1,350.00	Professional		$1,155.00	$1,275.00	$1,350.00
United Facility/Professional Professional Modifier Low / Median / High Price $1,250.00 / $1,250.00 / $1,500.00	Professional		$1,250.00	$1,250.00	$1,500.00
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $1,000.00 / $1,000.00 / $1,000.00	Professional		$1,000.00	$1,000.00	$1,000.00