Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $1,224.00 / $1,224.00 / $1,224.00	Facility		$1,224.00	$1,224.00	$1,224.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,152.00 / $1,224.00 / $1,224.00	Professional		$1,152.00	$1,224.00	$1,224.00
Asuris Northwest Health Facility/Professional Facility Modifier Low / Median / High Price $1,195.20 / $1,368.00 / $5,400.00	Facility		$1,195.20	$1,368.00	$5,400.00
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $1,224.00 / $5,472.00 / $6,480.00	Professional		$1,224.00	$5,472.00	$6,480.00
Cigna Facility/Professional Facility Modifier Low / Median / High Price $1,224.00 / $1,224.00 / $2,448.00	Facility		$1,224.00	$1,224.00	$2,448.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,224.00 / $1,224.00 / $1,224.00	Professional		$1,224.00	$1,224.00	$1,224.00
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $12.82 / $12.82 / $12.82	Professional		$12.82	$12.82	$12.82
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 $395.15 / $79,999.20 / $79,999.20	Facility		$395.15	$79,999.20	$79,999.20
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $1,195.20 / $1,195.20 / $1,224.00	Facility		$1,195.20	$1,195.20	$1,224.00
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $1,108.80 / $1,224.00 / $1,296.00	Professional		$1,108.80	$1,224.00	$1,296.00
United Facility/Professional Professional Modifier Low / Median / High Price $1,200.00 / $1,200.00 / $1,440.00	Professional		$1,200.00	$1,200.00	$1,440.00
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $386.49 / $386.49 / $386.49	Professional		$386.49	$386.49	$386.49