Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $2,157.10 / $2,157.10 / $2,157.10	Facility		$2,157.10	$2,157.10	$2,157.10
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,961.00 / $2,137.48 / $2,157.10	Professional		$1,961.00	$2,137.48	$2,157.10
Asuris Northwest Health Facility/Professional Facility Modifier Low / Median / High Price $1,632.00 / $2,679.00 / $6,562.50	Facility		$1,632.00	$2,679.00	$6,562.50
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $1,764.90 / $1,961.00 / $8,550.00	Professional		$1,764.90	$1,961.00	$8,550.00
Cigna Facility/Professional Facility Modifier Low / Median / High Price $1,850.00 / $1,850.00 / $4,028.00	Facility		$1,850.00	$1,850.00	$4,028.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,961.00 / $1,961.00 / $2,405.00	Professional		$1,961.00	$1,961.00	$2,405.00
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $1,961.00 / $1,961.00 / $2,647.35	Facility		$1,961.00	$1,961.00	$2,647.35
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $1,961.00 / $1,961.00 / $2,647.35	Professional		$1,961.00	$1,961.00	$2,647.35
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 $1,855.00 / $1,961.00 / $4,070.00	Facility		$1,855.00	$1,961.00	$4,070.00
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $1,593.60 / $1,593.60 / $1,632.00	Facility		$1,593.60	$1,593.60	$1,632.00
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $1,478.40 / $1,632.00 / $1,728.00	Professional		$1,478.40	$1,632.00	$1,728.00
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $1,961.00 / $1,961.00 / $1,961.00	Facility		$1,961.00	$1,961.00	$1,961.00
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $1,862.95 / $1,961.00 / $1,961.00	Professional		$1,862.95	$1,961.00	$1,961.00
United Facility/Professional Professional Modifier Low / Median / High Price $1,961.00 / $1,961.00 / $2,353.19	Professional		$1,961.00	$1,961.00	$2,353.19
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $1,961.00 / $1,961.00 / $1,961.00	Professional		$1,961.00	$1,961.00	$1,961.00