Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $1,643.85 / $1,643.85 / $1,643.85	Facility		$1,643.85	$1,643.85	$1,643.85
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,494.41 / $1,634.77 / $1,681.04	Professional		$1,494.41	$1,634.77	$1,681.04
Asuris Northwest Health Facility/Professional Facility Modifier Low / Median / High Price $872.87 / $1,691.21 / $7,066.85	Facility		$872.87	$1,691.21	$7,066.85
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $1,494.41 / $1,494.41 / $7,066.85	Professional		$1,494.41	$1,494.41	$7,066.85
Cigna Facility/Professional Facility Modifier Low / Median / High Price $1,409.82 / $1,409.82 / $2,988.70	Facility		$1,409.82	$1,409.82	$2,988.70
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,494.41 / $1,494.41 / $1,832.77	Professional		$1,494.41	$1,494.41	$1,832.77
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $1,494.41 / $1,494.41 / $2,709.18	Facility		$1,494.41	$1,494.41	$2,709.18
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $1,494.41 / $1,494.41 / $2,450.83	Professional		$1,494.41	$1,494.41	$2,450.83
Molina Facility/Professional Professional Modifier Low / Median / High Price $30.00 / $75.00 / $1,494.41	Professional		$30.00	$75.00	$1,494.41
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $1,494.41 / $1,542.24 / $2,824.43	Facility		$1,494.41	$1,542.24	$2,824.43
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $837.37 / $1,151.55 / $2,349.56	Facility		$837.37	$1,151.55	$2,349.56
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $1,691.21 / $1,766.70 / $2,941.48	Professional		$1,691.21	$1,766.70	$2,941.48
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $1,253.89 / $1,494.41 / $1,494.41	Facility		$1,253.89	$1,494.41	$1,494.41
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $1,419.69 / $1,494.41 / $1,494.41	Professional		$1,419.69	$1,494.41	$1,494.41
United Facility/Professional Professional Modifier Low / Median / High Price $1,494.41 / $1,494.41 / $1,793.29	Professional		$1,494.41	$1,494.41	$1,793.29
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $1,494.41 / $1,494.41 / $1,600.61	Professional		$1,494.41	$1,494.41	$1,600.61