Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $816.60 / $816.60 / $816.60	Facility		$816.60	$816.60	$816.60
Aetna Facility/Professional Professional Modifier Low / Median / High Price $714.82 / $948.30 / $1,296.02	Professional		$714.82	$948.30	$1,296.02
Asuris Northwest Health Facility/Professional Facility Modifier Low / Median / High Price $100.00 / $6,600.33 / $6,600.33	Facility		$100.00	$6,600.33	$6,600.33
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $916.37 / $2,237.34 / $10,855.13	Professional		$916.37	$2,237.34	$10,855.13
Cigna Facility/Professional Facility Modifier Low / Median / High Price $936.57 / $936.57 / $936.57	Facility		$936.57	$936.57	$936.57
Cigna Facility/Professional Professional Modifier Low / Median / High Price $796.08 / $796.08 / $936.57	Professional		$796.08	$796.08	$936.57
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $1,919.61 / $2,330.67 / $3,579.39	Facility		$1,919.61	$2,330.67	$3,579.39
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $1,105.23 / $2,251.75 / $4,088.80	Professional		$1,105.23	$2,251.75	$4,088.80
Molina Facility/Professional Professional Modifier Low / Median / High Price $60.00 / $125.76 / $125.76	Professional		$60.00	$125.76	$125.76
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $2,050.94 / $2,463.44 / $2,498.42	Facility		$2,050.94	$2,463.44	$2,498.42
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $2,050.94 / $2,463.44 / $2,498.42	Professional		$2,050.94	$2,463.44	$2,498.42
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $143.27 / $143.27 / $143.27	Facility		$143.27	$143.27	$143.27
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $1,037.84 / $1,221.00 / $2,887.11	Professional		$1,037.84	$1,221.00	$2,887.11
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $181.90 / $181.90 / $221.48	Professional		$181.90	$181.90	$221.48
United Facility/Professional Professional Modifier Low / Median / High Price $78.19 / $125.78 / $496.52	Professional		$78.19	$125.78	$496.52
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $1,031.53 / $1,031.53 / $1,031.53	Professional		$1,031.53	$1,031.53	$1,031.53