Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $2,724.50 / $5,969.74 / $21,917.86	Facility		$2,724.50	$5,969.74	$21,917.86
Aetna Facility/Professional Professional Modifier Low / Median / High Price $2,026.01 / $2,724.50 / $5,969.74	Professional		$2,026.01	$2,724.50	$5,969.74
Asuris Northwest Health Facility/Professional Facility Modifier Low / Median / High Price $2,956.79 / $15,127.44 / $28,937.08	Facility		$2,956.79	$15,127.44	$28,937.08
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $3,043.49 / $4,695.31 / $22,628.38	Professional		$3,043.49	$4,695.31	$22,628.38
Cigna Facility/Professional Facility Modifier Low / Median / High Price $765.00 / $870.49 / $870.49	Facility		$765.00	$870.49	$870.49
Cigna Facility/Professional Professional Modifier Low / Median / High Price $2,356.09 / $4,051.43 / $6,531.29	Professional		$2,356.09	$4,051.43	$6,531.29
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $2,184.78 / $4,286.88 / $5,940.63	Facility		$2,184.78	$4,286.88	$5,940.63
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $2,072.96 / $4,180.26 / $5,473.18	Professional		$2,072.96	$4,180.26	$5,473.18
Molina Facility/Professional Professional Modifier Low / Median / High Price $257.07 / $1,191.44 / $4,154.58	Professional		$257.07	$1,191.44	$4,154.58
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $3,064.95 / $4,167.39 / $4,334.89	Facility		$3,064.95	$4,167.39	$4,334.89
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $2,892.86 / $2,892.86 / $2,956.79	Facility		$2,892.86	$2,892.86	$2,956.79
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $3,318.12 / $4,725.64 / $5,868.94	Professional		$3,318.12	$4,725.64	$5,868.94
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $11,555.00 / $15,127.44 / $28,937.08	Facility		$11,555.00	$15,127.44	$28,937.08
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $2,950.33 / $4,208.60 / $5,603.02	Professional		$2,950.33	$4,208.60	$5,603.02
United Facility/Professional Facility Modifier Low / Median / High Price $2,912.00 / $4,016.00 / $16,315.00	Facility		$2,912.00	$4,016.00	$16,315.00
United Facility/Professional Professional Modifier Low / Median / High Price $2,612.40 / $3,591.96 / $6,157.79	Professional		$2,612.40	$3,591.96	$6,157.79
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $1,786.71 / $1,786.71 / $2,291.96	Professional		$1,786.71	$1,786.71	$2,291.96