Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $729.99 / $729.99 / $729.99	Facility		$729.99	$729.99	$729.99
Aetna Facility/Professional Professional Modifier Low / Median / High Price $663.63 / $729.99 / $782.38	Professional		$663.63	$729.99	$782.38
Asuris Northwest Health Facility/Professional Facility Modifier Low / Median / High Price $663.63 / $1,215.45 / $3,792.20	Facility		$663.63	$1,215.45	$3,792.20
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $663.63 / $663.63 / $4,000.00	Professional		$663.63	$663.63	$4,000.00
Cigna Facility/Professional Facility Modifier Low / Median / High Price $626.05 / $626.05 / $1,438.74	Facility		$626.05	$626.05	$1,438.74
Cigna Facility/Professional Professional Modifier Low / Median / High Price $663.63 / $663.63 / $813.88	Professional		$663.63	$663.63	$813.88
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $663.63 / $663.63 / $895.90	Facility		$663.63	$663.63	$895.90
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $663.63 / $663.63 / $829.54	Professional		$663.63	$663.63	$829.54
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 $663.63 / $717.78 / $1,489.73	Facility		$663.63	$717.78	$1,489.73
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $830.00 / $830.00 / $1,012.88	Facility		$830.00	$830.00	$1,012.88
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $931.84 / $1,012.88 / $1,661.11	Professional		$931.84	$1,012.88	$1,661.11
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $663.63 / $663.63 / $663.63	Facility		$663.63	$663.63	$663.63
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $630.45 / $663.63 / $663.63	Professional		$630.45	$663.63	$663.63
United Facility/Professional Professional Modifier Low / Median / High Price $663.63 / $663.63 / $796.36	Professional		$663.63	$663.63	$796.36
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $663.63 / $663.63 / $858.92	Professional		$663.63	$663.63	$858.92