Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $2,275.32 / $2,275.32 / $2,275.32	Facility		$2,275.32	$2,275.32	$2,275.32
Aetna Facility/Professional Professional Modifier Low / Median / High Price $2,068.46 / $2,275.32 / $2,420.42	Professional		$2,068.46	$2,275.32	$2,420.42
Asuris Northwest Health Facility/Professional Facility Modifier Low / Median / High Price $2,068.46 / $3,157.80 / $4,986.00	Facility		$2,068.46	$3,157.80	$4,986.00
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $1,923.68 / $2,068.46 / $14,958.00	Professional		$1,923.68	$2,068.46	$14,958.00
Cigna Facility/Professional Facility Modifier Low / Median / High Price $1,951.39 / $1,951.39 / $5,650.80	Facility		$1,951.39	$1,951.39	$5,650.80
Cigna Facility/Professional Professional Modifier Low / Median / High Price $2,068.46 / $2,068.46 / $2,536.81	Professional		$2,068.46	$2,068.46	$2,536.81
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $2,068.46 / $2,068.46 / $2,792.43	Facility		$2,068.46	$2,068.46	$2,792.43
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $2,068.46 / $2,068.46 / $2,585.59	Professional		$2,068.46	$2,068.46	$2,585.59
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 $2,068.46 / $2,220.57 / $4,293.06	Facility		$2,068.46	$2,220.57	$4,293.06
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $2,758.92 / $2,758.92 / $2,825.40	Facility		$2,758.92	$2,758.92	$2,825.40
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $2,559.48 / $2,825.40 / $2,991.60	Professional		$2,559.48	$2,825.40	$2,991.60
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $2,068.46 / $2,068.46 / $2,068.46	Facility		$2,068.46	$2,068.46	$2,068.46
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $1,965.05 / $2,068.46 / $2,068.46	Professional		$1,965.05	$2,068.46	$2,068.46
United Facility/Professional Professional Modifier Low / Median / High Price $2,068.46 / $2,068.46 / $2,482.16	Professional		$2,068.46	$2,068.46	$2,482.16
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $176.06 / $2,068.46 / $2,068.46	Professional		$176.06	$2,068.46	$2,068.46