Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $784.85 / $784.85 / $784.85	Facility		$784.85	$784.85	$784.85
Aetna Facility/Professional Professional Modifier Low / Median / High Price $713.50 / $784.85 / $856.20	Professional		$713.50	$784.85	$856.20
Asuris Northwest Health Facility/Professional Facility Modifier Low / Median / High Price $713.50 / $1,812.38 / $5,654.61	Facility		$713.50	$1,812.38	$5,654.61
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $713.50 / $713.50 / $5,654.61	Professional		$713.50	$713.50	$5,654.61
Cigna Facility/Professional Facility Modifier Low / Median / High Price $673.11 / $673.11 / $1,950.52	Facility		$673.11	$673.11	$1,950.52
Cigna Facility/Professional Professional Modifier Low / Median / High Price $713.50 / $713.50 / $875.05	Professional		$713.50	$713.50	$875.05
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $713.50 / $713.50 / $963.22	Facility		$713.50	$713.50	$963.22
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $713.50 / $713.50 / $963.22	Professional		$713.50	$713.50	$963.22
Molina Facility/Professional Professional Modifier Low / Median / High Price $45.00 / $50.00 / $75.00	Professional		$45.00	$50.00	$75.00
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $713.50 / $941.46 / $1,596.32	Facility		$713.50	$941.46	$1,596.32
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $1,319.70 / $1,319.70 / $1,353.23	Facility		$1,319.70	$1,319.70	$1,353.23
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $1,353.23 / $1,389.48 / $2,353.65	Professional		$1,353.23	$1,389.48	$2,353.65
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $713.50 / $713.50 / $713.50	Facility		$713.50	$713.50	$713.50
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $677.83 / $713.50 / $713.50	Professional		$677.83	$713.50	$713.50
United Facility/Professional Professional Modifier Low / Median / High Price $713.50 / $713.50 / $856.20	Professional		$713.50	$713.50	$856.20
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $713.50 / $713.50 / $1,280.74	Professional		$713.50	$713.50	$1,280.74