Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $1,789.92 / $5,128.00 / $21,917.86	Facility		$1,789.92	$5,128.00	$21,917.86
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,306.24 / $1,789.92 / $3,829.86	Professional		$1,306.24	$1,789.92	$3,829.86
Asuris Northwest Health Facility/Professional Facility Modifier Low / Median / High Price $1,929.45 / $14,791.76 / $28,937.08	Facility		$1,929.45	$14,791.76	$28,937.08
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $1,986.03 / $3,243.95 / $12,236.85	Professional		$1,986.03	$3,243.95	$12,236.85
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 $1,404.76 / $2,527.60 / $4,277.16	Professional		$1,404.76	$2,527.60	$4,277.16
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $1,340.75 / $2,682.10 / $3,878.22	Facility		$1,340.75	$2,682.10	$3,878.22
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $1,340.75 / $2,658.33 / $3,551.05	Professional		$1,340.75	$2,658.33	$3,551.05
Molina Facility/Professional Professional Modifier Low / Median / High Price $157.08 / $821.49 / $2,787.77	Professional		$157.08	$821.49	$2,787.77
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $1,786.54 / $2,452.19 / $2,828.74	Facility		$1,786.54	$2,452.19	$2,828.74
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $1,885.39 / $1,885.39 / $1,929.45	Facility		$1,885.39	$1,885.39	$1,929.45
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $2,162.07 / $3,079.88 / $3,829.78	Professional		$2,162.07	$3,079.88	$3,829.78
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 $1,922.84 / $2,746.32 / $3,656.25	Professional		$1,922.84	$2,746.32	$3,656.25
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 $1,640.69 / $2,281.57 / $4,036.22	Professional		$1,640.69	$2,281.57	$4,036.22
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $1,176.32 / $1,176.32 / $1,521.47	Professional		$1,176.32	$1,176.32	$1,521.47