Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $1,649.70 / $5,465.07 / $12,530.70	Facility		$1,649.70	$5,465.07	$12,530.70
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,105.65 / $1,649.70 / $1,702.35	Professional		$1,105.65	$1,649.70	$1,702.35
Asuris Northwest Health Facility/Professional Facility Modifier Low / Median / High Price $1,842.75 / $2,879.96 / $8,336.25	Facility		$1,842.75	$2,879.96	$8,336.25
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $1,579.50 / $4,958.32 / $13,162.50	Professional		$1,579.50	$4,958.32	$13,162.50
Cigna Facility/Professional Facility Modifier Low / Median / High Price $1,825.20 / $3,730.59 / $4,531.63	Facility		$1,825.20	$3,730.59	$4,531.63
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $1,579.50 / $1,755.00 / $2,983.50	Facility		$1,579.50	$1,755.00	$2,983.50
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $1,579.50 / $1,755.00 / $4,387.50	Professional		$1,579.50	$1,755.00	$4,387.50
Molina Facility/Professional Professional Modifier Low / Median / High Price $75.00 / $75.00 / $75.00	Professional		$75.00	$75.00	$75.00
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $1,755.00 / $1,755.00 / $2,457.00	Facility		$1,755.00	$1,755.00	$2,457.00
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $1,755.00 / $3,071.25 / $5,265.00	Facility		$1,755.00	$3,071.25	$5,265.00
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $1,579.50 / $2,193.75 / $2,650.05	Professional		$1,579.50	$2,193.75	$2,650.05
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $1,842.75 / $2,895.75 / $4,826.25	Facility		$1,842.75	$2,895.75	$4,826.25
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $1,941.03 / $3,429.33 / $4,080.53	Professional		$1,941.03	$3,429.33	$4,080.53
United Facility/Professional Professional Modifier Low / Median / High Price $737.10 / $737.10 / $1,965.60	Professional		$737.10	$737.10	$1,965.60