Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $2,092.88 / $2,092.88 / $2,092.88	Facility		$2,092.88	$2,092.88	$2,092.88
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,902.62 / $2,092.88 / $2,221.96	Professional		$1,902.62	$2,092.88	$2,221.96
Asuris Northwest Health Facility/Professional Facility Modifier Low / Median / High Price $1,902.62 / $3,125.84 / $8,437.50	Facility		$1,902.62	$3,125.84	$8,437.50
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $1,902.62 / $1,902.62 / $10,800.00	Professional		$1,902.62	$1,902.62	$10,800.00
Cigna Facility/Professional Facility Modifier Low / Median / High Price $1,794.93 / $1,794.93 / $4,699.84	Facility		$1,794.93	$1,794.93	$4,699.84
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,902.62 / $1,902.62 / $2,333.40	Professional		$1,902.62	$1,902.62	$2,333.40
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $1,902.62 / $1,902.62 / $2,568.54	Facility		$1,902.62	$1,902.62	$2,568.54
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $1,902.62 / $1,902.62 / $2,568.54	Professional		$1,902.62	$1,902.62	$2,568.54
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 $1,902.62 / $2,038.50 / $3,957.45	Facility		$1,902.62	$2,038.50	$3,957.45
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $2,241.00 / $2,241.00 / $2,295.00	Facility		$2,241.00	$2,241.00	$2,295.00
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $2,079.00 / $2,295.00 / $2,430.00	Professional		$2,079.00	$2,295.00	$2,430.00
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $1,902.62 / $1,902.62 / $1,902.62	Facility		$1,902.62	$1,902.62	$1,902.62
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $1,807.49 / $1,902.62 / $1,902.62	Professional		$1,807.49	$1,902.62	$1,902.62
United Facility/Professional Professional Modifier Low / Median / High Price $1,902.62 / $1,902.62 / $2,283.14	Professional		$1,902.62	$1,902.62	$2,283.14
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $1,902.62 / $1,902.62 / $2,464.69	Professional		$1,902.62	$1,902.62	$2,464.69