Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $1,289.81 / $1,289.81 / $1,289.81	Facility		$1,289.81	$1,289.81	$1,289.81
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,172.56 / $1,270.28 / $1,289.81	Professional		$1,172.56	$1,270.28	$1,289.81
Asuris Northwest Health Facility/Professional Facility Modifier Low / Median / High Price $1,120.50 / $1,586.25 / $3,675.00	Facility		$1,120.50	$1,586.25	$3,675.00
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $1,081.29 / $4,725.00 / $4,725.00	Professional		$1,081.29	$4,725.00	$4,725.00
Cigna Facility/Professional Facility Modifier Low / Median / High Price $1,106.19 / $1,106.19 / $2,385.00	Facility		$1,106.19	$1,106.19	$2,385.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,172.56 / $1,172.56 / $1,438.04	Professional		$1,172.56	$1,172.56	$1,438.04
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $1,172.56 / $1,172.56 / $1,582.96	Facility		$1,172.56	$1,172.56	$1,582.96
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $1,172.56 / $1,172.56 / $1,582.96	Professional		$1,172.56	$1,172.56	$1,582.96
Molina Facility/Professional Professional Modifier Low / Median / High Price $50.00 / $75.00 / $75.00	Professional		$50.00	$75.00	$75.00
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $1,038.80 / $1,172.56 / $2,418.73	Facility		$1,038.80	$1,172.56	$2,418.73
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $1,120.50 / $1,120.50 / $1,147.50	Facility		$1,120.50	$1,120.50	$1,147.50
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $1,039.50 / $1,147.50 / $1,215.00	Professional		$1,039.50	$1,147.50	$1,215.00
United Facility/Professional Professional Modifier Low / Median / High Price $1,172.56 / $1,172.56 / $1,407.07	Professional		$1,172.56	$1,172.56	$1,407.07
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $1,038.80 / $1,172.56 / $1,172.56	Professional		$1,038.80	$1,172.56	$1,172.56