Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $1,597.48 / $1,597.48 / $1,597.48	Facility		$1,597.48	$1,597.48	$1,597.48
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,452.25 / $1,597.48 / $1,742.70	Professional		$1,452.25	$1,597.48	$1,742.70
Asuris Northwest Health Facility/Professional Facility Modifier Low / Median / High Price $1,452.25 / $2,550.00 / $6,878.66	Facility		$1,452.25	$2,550.00	$6,878.66
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $1,452.25 / $1,452.25 / $6,878.66	Professional		$1,452.25	$1,452.25	$6,878.66
Cigna Facility/Professional Facility Modifier Low / Median / High Price $1,370.05 / $1,370.05 / $3,289.98	Facility		$1,370.05	$1,370.05	$3,289.98
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,452.25 / $1,452.25 / $1,781.06	Professional		$1,452.25	$1,452.25	$1,781.06
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $1,452.25 / $1,452.25 / $1,960.54	Facility		$1,452.25	$1,452.25	$1,960.54
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $1,452.25 / $1,452.25 / $1,960.54	Professional		$1,452.25	$1,452.25	$1,960.54
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 $883.62 / $1,452.25 / $2,760.06	Facility		$883.62	$1,452.25	$2,760.06
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $1,494.00 / $1,494.00 / $1,646.18	Facility		$1,494.00	$1,494.00	$1,646.18
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $1,646.18 / $1,690.27 / $2,863.17	Professional		$1,646.18	$1,690.27	$2,863.17
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $1,452.25 / $1,452.25 / $1,452.25	Facility		$1,452.25	$1,452.25	$1,452.25
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $1,379.64 / $1,452.25 / $1,452.25	Professional		$1,379.64	$1,452.25	$1,452.25
United Facility/Professional Facility Modifier Low / Median / High Price $1,644.99 / $1,644.99 / $1,644.99	Facility		$1,644.99	$1,644.99	$1,644.99
United Facility/Professional Professional Modifier Low / Median / High Price $1,452.25 / $1,452.25 / $1,742.70	Professional		$1,452.25	$1,452.25	$1,742.70
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $1,452.25 / $1,452.25 / $1,557.99	Professional		$1,452.25	$1,452.25	$1,557.99