Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $499.20 / $519.35 / $818.64	Professional		$499.20	$519.35	$818.64
Asuris Northwest Health Facility/Professional Facility Modifier Low / Median / High Price $90.96 / $4,660.41 / $4,660.41	Facility		$90.96	$4,660.41	$4,660.41
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $676.20 / $773.30 / $1,142.57	Professional		$676.20	$773.30	$1,142.57
Cigna Facility/Professional Facility Modifier Low / Median / High Price $2,355.54 / $2,355.54 / $2,355.54	Facility		$2,355.54	$2,355.54	$2,355.54
Cigna Facility/Professional Professional Modifier Low / Median / High Price $77.09 / $2,002.21 / $2,355.54	Professional		$77.09	$2,002.21	$2,355.54
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $1,038.70 / $1,038.70 / $1,038.70	Facility		$1,038.70	$1,038.70	$1,038.70
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $1,038.70 / $1,038.70 / $1,038.70	Professional		$1,038.70	$1,038.70	$1,038.70
Molina Facility/Professional Professional Modifier Low / Median / High Price $770.49 / $912.96 / $1,115.83	Professional		$770.49	$912.96	$1,115.83
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $1,448.15 / $1,739.41 / $7,371.41	Facility		$1,448.15	$1,739.41	$7,371.41
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $1,448.15 / $1,739.41 / $1,764.11	Professional		$1,448.15	$1,739.41	$1,764.11
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $90.96 / $90.96 / $90.96	Facility		$90.96	$90.96	$90.96
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $86.22 / $862.24 / $1,166.56	Professional		$86.22	$862.24	$1,166.56
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $85.41 / $85.41 / $85.41	Professional		$85.41	$85.41	$85.41
United Facility/Professional Professional Modifier Low / Median / High Price $419.12 / $437.19 / $728.65	Professional		$419.12	$437.19	$728.65
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $773.30 / $773.30 / $773.30	Professional		$773.30	$773.30	$773.30