Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $1,532.43 / $1,532.43 / $1,532.43	Facility		$1,532.43	$1,532.43	$1,532.43
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,393.12 / $1,532.43 / $1,671.74	Professional		$1,393.12	$1,532.43	$1,671.74
Asuris Northwest Health Facility/Professional Facility Modifier Low / Median / High Price $1,393.12 / $2,340.00 / $8,775.00	Facility		$1,393.12	$2,340.00	$8,775.00
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $1,393.12 / $1,393.12 / $9,360.00	Professional		$1,393.12	$1,393.12	$9,360.00
Cigna Facility/Professional Facility Modifier Low / Median / High Price $1,314.26 / $1,314.26 / $3,216.54	Facility		$1,314.26	$1,314.26	$3,216.54
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,393.12 / $1,393.12 / $1,708.54	Professional		$1,393.12	$1,393.12	$1,708.54
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $1,393.12 / $1,393.12 / $1,880.71	Facility		$1,393.12	$1,393.12	$1,880.71
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $1,393.12 / $1,393.12 / $1,741.40	Professional		$1,393.12	$1,393.12	$1,741.40
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 $1,393.12 / $1,713.18 / $3,555.66	Facility		$1,393.12	$1,713.18	$3,555.66
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $1,942.20 / $1,942.20 / $1,989.00	Facility		$1,942.20	$1,942.20	$1,989.00
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $1,801.80 / $1,989.00 / $2,106.00	Professional		$1,801.80	$1,989.00	$2,106.00
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $1,393.12 / $1,393.12 / $1,393.12	Facility		$1,393.12	$1,393.12	$1,393.12
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $1,323.46 / $1,393.12 / $1,393.12	Professional		$1,323.46	$1,393.12	$1,393.12
United Facility/Professional Professional Modifier Low / Median / High Price $1,393.12 / $1,393.12 / $1,671.74	Professional		$1,393.12	$1,393.12	$1,671.74
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $1,393.12 / $1,393.12 / $1,393.12	Professional		$1,393.12	$1,393.12	$1,393.12