Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $1,805.02 / $1,805.02 / $1,805.02	Facility		$1,805.02	$1,805.02	$1,805.02
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,640.93 / $1,788.61 / $1,805.02	Professional		$1,640.93	$1,788.61	$1,805.02
Asuris Northwest Health Facility/Professional Facility Modifier Low / Median / High Price $1,326.00 / $2,171.85 / $5,493.04	Facility		$1,326.00	$2,171.85	$5,493.04
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $1,476.84 / $1,640.93 / $6,941.34	Professional		$1,476.84	$1,640.93	$6,941.34
Cigna Facility/Professional Facility Modifier Low / Median / High Price $644.29 / $1,548.05 / $1,640.93	Facility		$644.29	$1,548.05	$1,640.93
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,640.93 / $1,640.93 / $2,012.46	Professional		$1,640.93	$1,640.93	$2,012.46
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $1,640.93 / $1,640.93 / $2,215.26	Facility		$1,640.93	$1,640.93	$2,215.26
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $1,640.93 / $1,640.93 / $2,215.26	Professional		$1,640.93	$1,640.93	$2,215.26
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 $1,552.70 / $1,640.93 / $3,405.70	Facility		$1,552.70	$1,640.93	$3,405.70
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $1,294.80 / $1,294.80 / $1,326.00	Facility		$1,294.80	$1,294.80	$1,326.00
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $1,201.20 / $1,326.00 / $1,404.00	Professional		$1,201.20	$1,326.00	$1,404.00
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $1,640.93 / $1,640.93 / $1,640.93	Facility		$1,640.93	$1,640.93	$1,640.93
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $1,558.88 / $1,640.93 / $1,640.93	Professional		$1,558.88	$1,640.93	$1,640.93
United Facility/Professional Professional Modifier Low / Median / High Price $1,640.93 / $1,640.93 / $1,773.99	Professional		$1,640.93	$1,640.93	$1,773.99
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $1,635.07 / $1,640.93 / $1,640.93	Professional		$1,635.07	$1,640.93	$1,640.93