Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $840.00 / $1,680.00 / $3,812.26	Facility		$840.00	$1,680.00	$3,812.26
Aetna Facility/Professional Professional Modifier Low / Median / High Price $378.44 / $446.55 / $1,013.67	Professional		$378.44	$446.55	$1,013.67
Asuris Northwest Health Facility/Professional Facility Modifier Low / Median / High Price $579.41 / $1,376.32 / $3,157.08	Facility		$579.41	$1,376.32	$3,157.08
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $471.21 / $579.09 / $3,413.19	Professional		$471.21	$579.09	$3,413.19
Cigna Facility/Professional Facility Modifier Low / Median / High Price $419.48 / $419.48 / $419.48	Facility		$419.48	$419.48	$419.48
Cigna Facility/Professional Professional Modifier Low / Median / High Price $306.22 / $306.22 / $429.15	Professional		$306.22	$306.22	$429.15
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $380.83 / $661.72 / $1,733.43	Facility		$380.83	$661.72	$1,733.43
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $381.25 / $669.34 / $1,285.09	Professional		$381.25	$669.34	$1,285.09
Molina Facility/Professional Professional Modifier Low / Median / High Price $456.54 / $507.27 / $557.99	Professional		$456.54	$507.27	$557.99
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $525.25 / $646.21 / $685.38	Facility		$525.25	$646.21	$685.38
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $595.54 / $661.72 / $685.38	Professional		$595.54	$661.72	$685.38
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $579.41 / $743.14 / $1,292.42	Facility		$579.41	$743.14	$1,292.42
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $629.83 / $646.21 / $646.21	Facility		$629.83	$646.21	$646.21
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $525.66 / $562.46 / $727.89	Professional		$525.66	$562.46	$727.89
United Facility/Professional Professional Modifier Low / Median / High Price $279.36 / $325.92 / $576.46	Professional		$279.36	$325.92	$576.46
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $396.47 / $396.47 / $396.47	Professional		$396.47	$396.47	$396.47