Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $3,264.00 / $3,264.00 / $3,264.00	Facility		$3,264.00	$3,264.00	$3,264.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $3,110.40 / $3,264.00 / $3,302.40	Professional		$3,110.40	$3,264.00	$3,302.40
Asuris Northwest Health Facility/Professional Facility Modifier Low / Median / High Price $3,648.00 / $17,490.00 / $17,490.00	Facility		$3,648.00	$17,490.00	$17,490.00
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $3,300.00 / $3,648.00 / $17,280.00	Professional		$3,300.00	$3,648.00	$17,280.00
Cigna Facility/Professional Facility Modifier Low / Median / High Price $3,264.00 / $6,528.00 / $13,464.00	Facility		$3,264.00	$6,528.00	$13,464.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $3,264.00 / $3,264.00 / $3,264.00	Professional		$3,264.00	$3,264.00	$3,264.00
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $3,648.00 / $9,383.68 / $28,685.25	Facility		$3,648.00	$9,383.68	$28,685.25
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $3,648.00 / $3,970.35 / $3,970.35	Professional		$3,648.00	$3,970.35	$3,970.35
Molina Facility/Professional Professional Modifier Low / Median / High Price $50.00 / $50.00 / $75.00	Professional		$50.00	$50.00	$75.00
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $79,999.20 / $79,999.20 / $79,999.20	Facility		$79,999.20	$79,999.20	$79,999.20
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $3,648.00 / $3,648.00 / $3,648.00	Facility		$3,648.00	$3,648.00	$3,648.00
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $3,648.00 / $3,648.00 / $3,648.00	Professional		$3,648.00	$3,648.00	$3,648.00
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $3,135.00 / $3,648.00 / $8,710.02	Facility		$3,135.00	$3,648.00	$8,710.02
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $3,648.00 / $3,648.00 / $3,793.92	Professional		$3,648.00	$3,648.00	$3,793.92
United Facility/Professional Professional Modifier Low / Median / High Price $3,200.00 / $3,200.00 / $3,200.00	Professional		$3,200.00	$3,200.00	$3,200.00