Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $120.38 / $120.38 / $120.38	Facility		$120.38	$120.38	$120.38
Aetna Facility/Professional Professional Modifier Low / Median / High Price $109.44 / $120.38 / $131.32	Professional		$109.44	$120.38	$131.32
Asuris Northwest Health Facility/Professional Facility Modifier Low / Median / High Price $1,384.44 / $1,417.80 / $1,668.00	Facility		$1,384.44	$1,417.80	$1,668.00
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $184.21 / $1,668.00 / $1,668.00	Professional		$184.21	$1,668.00	$1,668.00
Cigna Facility/Professional Facility Modifier Low / Median / High Price $103.24 / $103.24 / $412.96	Facility		$103.24	$103.24	$412.96
Cigna Facility/Professional Professional Modifier Low / Median / High Price $109.44 / $109.44 / $134.21	Professional		$109.44	$109.44	$134.21
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $109.44 / $109.44 / $147.74	Facility		$109.44	$109.44	$147.74
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $109.44 / $109.44 / $147.74	Professional		$109.44	$109.44	$147.74
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 $109.44 / $130.11 / $238.38	Facility		$109.44	$130.11	$238.38
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $400.22 / $1,384.44 / $1,384.44	Facility		$400.22	$1,384.44	$1,384.44
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $287.66 / $325.18 / $512.79	Professional		$287.66	$325.18	$512.79
United Facility/Professional Professional Modifier Low / Median / High Price $109.44 / $109.44 / $131.33	Professional		$109.44	$109.44	$131.33
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $109.44 / $109.44 / $265.14	Professional		$109.44	$109.44	$265.14