Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $2,077.16 / $5,128.00 / $21,917.86	Facility		$2,077.16	$5,128.00	$21,917.86
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,507.96 / $2,077.16 / $4,666.62	Professional		$1,507.96	$2,077.16	$4,666.62
Asuris Northwest Health Facility/Professional Facility Modifier Low / Median / High Price $2,150.19 / $14,791.76 / $28,937.08	Facility		$2,150.19	$14,791.76	$28,937.08
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $2,213.23 / $3,438.03 / $15,441.12	Professional		$2,213.23	$3,438.03	$15,441.12
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 $1,687.50 / $2,929.19 / $4,817.79	Professional		$1,687.50	$2,929.19	$4,817.79
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $1,614.79 / $3,186.38 / $4,670.91	Facility		$1,614.79	$3,186.38	$4,670.91
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $1,614.79 / $3,147.52 / $4,104.68	Professional		$1,614.79	$3,147.52	$4,104.68
Molina Facility/Professional Professional Modifier Low / Median / High Price $157.37 / $931.65 / $3,082.42	Professional		$157.37	$931.65	$3,082.42
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $2,280.54 / $3,094.85 / $3,179.68	Facility		$2,280.54	$3,094.85	$3,179.68
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $2,118.23 / $2,118.23 / $2,150.19	Facility		$2,118.23	$2,118.23	$2,150.19
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $2,424.62 / $3,420.54 / $4,267.91	Professional		$2,424.62	$3,420.54	$4,267.91
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 $2,160.31 / $3,060.51 / $4,155.21	Professional		$2,160.31	$3,060.51	$4,155.21
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 $1,955.94 / $2,542.58 / $4,556.21	Professional		$1,955.94	$2,542.58	$4,556.21
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $1,306.90 / $1,306.90 / $1,707.61	Professional		$1,306.90	$1,306.90	$1,707.61