Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $1,361.01 / $1,361.01 / $1,361.01	Facility		$1,361.01	$1,361.01	$1,361.01
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,237.28 / $1,297.58 / $1,361.01	Professional		$1,237.28	$1,297.58	$1,361.01
Asuris Northwest Health Facility/Professional Facility Modifier Low / Median / High Price $1,237.28 / $2,408.92 / $5,119.78	Facility		$1,237.28	$2,408.92	$5,119.78
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $1,237.28 / $1,237.28 / $5,563.22	Professional		$1,237.28	$1,237.28	$5,563.22
Cigna Facility/Professional Facility Modifier Low / Median / High Price $1,167.25 / $1,167.25 / $2,111.94	Facility		$1,167.25	$1,167.25	$2,111.94
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,237.28 / $1,237.28 / $1,517.42	Professional		$1,237.28	$1,237.28	$1,517.42
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $1,237.28 / $1,237.28 / $1,670.33	Facility		$1,237.28	$1,237.28	$1,670.33
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $1,237.28 / $1,237.28 / $1,670.33	Professional		$1,237.28	$1,237.28	$1,670.33
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 $1,190.44 / $1,237.28 / $2,338.46	Facility		$1,190.44	$1,237.28	$2,338.46
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $1,367.47 / $1,394.40 / $1,394.40	Facility		$1,367.47	$1,394.40	$1,394.40
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $1,258.08 / $1,367.47 / $2,131.07	Professional		$1,258.08	$1,367.47	$2,131.07
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $1,237.28 / $1,237.28 / $1,237.28	Facility		$1,237.28	$1,237.28	$1,237.28
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $1,175.42 / $1,237.28 / $1,237.28	Professional		$1,175.42	$1,237.28	$1,237.28
United Facility/Professional Professional Modifier Low / Median / High Price $1,055.97 / $1,237.28 / $1,337.61	Professional		$1,055.97	$1,237.28	$1,337.61
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $1,159.60 / $1,237.28 / $1,237.28	Professional		$1,159.60	$1,237.28	$1,237.28