Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $1,749.59 / $1,749.59 / $1,749.59	Facility		$1,749.59	$1,749.59	$1,749.59
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,590.54 / $1,749.59 / $1,802.66	Professional		$1,590.54	$1,749.59	$1,802.66
Asuris Northwest Health Facility/Professional Facility Modifier Low / Median / High Price $1,590.54 / $2,550.00 / $11,250.00	Facility		$1,590.54	$2,550.00	$11,250.00
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $1,590.54 / $1,590.54 / $12,000.00	Professional		$1,590.54	$1,590.54	$12,000.00
Cigna Facility/Professional Facility Modifier Low / Median / High Price $1,500.51 / $1,500.51 / $3,707.32	Facility		$1,500.51	$1,500.51	$3,707.32
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,590.54 / $1,590.54 / $1,950.66	Professional		$1,590.54	$1,590.54	$1,950.66
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $1,590.54 / $1,590.54 / $2,147.23	Facility		$1,590.54	$1,590.54	$2,147.23
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $1,590.54 / $1,590.54 / $1,988.18	Professional		$1,590.54	$1,590.54	$1,988.18
Molina Facility/Professional Professional Modifier Low / Median / High Price $50.00 / $50.00 / $75.00	Professional		$50.00	$50.00	$75.00
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $138.29 / $1,590.54 / $3,273.81	Facility		$138.29	$1,590.54	$3,273.81
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $2,490.00 / $2,490.00 / $2,550.00	Facility		$2,490.00	$2,490.00	$2,550.00
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $2,310.00 / $2,550.00 / $2,700.00	Professional		$2,310.00	$2,550.00	$2,700.00
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $1,590.54 / $1,590.54 / $1,590.54	Facility		$1,590.54	$1,590.54	$1,590.54
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $1,511.01 / $1,590.54 / $1,590.54	Professional		$1,511.01	$1,590.54	$1,590.54
United Facility/Professional Professional Modifier Low / Median / High Price $1,590.54 / $1,590.54 / $1,908.65	Professional		$1,590.54	$1,590.54	$1,908.65
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $1,590.54 / $1,590.54 / $1,855.90	Professional		$1,590.54	$1,590.54	$1,855.90