Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $640.32 / $640.32 / $640.32	Facility		$640.32	$640.32	$640.32
Aetna Facility/Professional Professional Modifier Low / Median / High Price $492.35 / $667.44 / $1,005.44	Professional		$492.35	$667.44	$1,005.44
Asuris Northwest Health Facility/Professional Facility Modifier Low / Median / High Price $100.00 / $4,782.72 / $4,832.10	Facility		$100.00	$4,782.72	$4,832.10
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $181.99 / $1,819.86 / $7,947.00	Professional		$181.99	$1,819.86	$7,947.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $750.60 / $750.60 / $750.60	Professional		$750.60	$750.60	$750.60
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $1,405.30 / $1,706.23 / $2,620.39	Facility		$1,405.30	$1,706.23	$2,620.39
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $809.11 / $1,648.84 / $2,993.41	Professional		$809.11	$1,648.84	$2,993.41
Molina Facility/Professional Professional Modifier Low / Median / High Price $70.00 / $92.08 / $153.63	Professional		$70.00	$92.08	$153.63
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $1,501.50 / $1,803.49 / $1,829.10	Facility		$1,501.50	$1,803.49	$1,829.10
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $1,501.50 / $1,803.49 / $1,829.10	Professional		$1,501.50	$1,803.49	$1,829.10
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $112.33 / $112.33 / $112.33	Facility		$112.33	$112.33	$112.33
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $75.98 / $759.90 / $1,145.77	Professional		$75.98	$759.90	$1,145.77
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $153.78 / $153.78 / $187.24	Professional		$153.78	$153.78	$187.24
United Facility/Professional Professional Modifier Low / Median / High Price $60.85 / $101.42 / $199.28	Professional		$60.85	$101.42	$199.28
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $700.20 / $700.20 / $700.20	Professional		$700.20	$700.20	$700.20