Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $2,174.51 / $11,093.00 / $22,024.00	Facility		$2,174.51	$11,093.00	$22,024.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,617.21 / $2,174.51 / $4,764.56	Professional		$1,617.21	$2,174.51	$4,764.56
Asuris Northwest Health Facility/Professional Facility Modifier Low / Median / High Price $2,298.71 / $18,633.84 / $35,644.43	Facility		$2,298.71	$18,633.84	$35,644.43
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $2,419.90 / $3,747.49 / $14,767.28	Professional		$2,419.90	$3,747.49	$14,767.28
Cigna Facility/Professional Facility Modifier Low / Median / High Price $714.97 / $765.00 / $870.49	Facility		$714.97	$765.00	$870.49
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,849.51 / $3,085.97 / $5,032.37	Professional		$1,849.51	$3,085.97	$5,032.37
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $1,872.99 / $3,460.95 / $4,842.18	Facility		$1,872.99	$3,460.95	$4,842.18
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $1,813.32 / $3,283.73 / $4,505.76	Professional		$1,813.32	$3,283.73	$4,505.76
Molina Facility/Professional Professional Modifier Low / Median / High Price $213.22 / $917.35 / $3,248.72	Professional		$213.22	$917.35	$3,248.72
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $2,210.77 / $3,210.48 / $3,398.24	Facility		$2,210.77	$3,210.48	$3,398.24
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $2,267.71 / $2,267.71 / $2,298.71	Facility		$2,267.71	$2,267.71	$2,298.71
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $2,572.08 / $3,656.81 / $4,562.71	Professional		$2,572.08	$3,656.81	$4,562.71
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $14,233.34 / $18,633.84 / $35,644.43	Facility		$14,233.34	$18,633.84	$35,644.43
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $2,312.77 / $3,271.91 / $4,454.07	Professional		$2,312.77	$3,271.91	$4,454.07
United Facility/Professional Facility Modifier Low / Median / High Price $3,028.00 / $5,547.00 / $19,271.00	Facility		$3,028.00	$5,547.00	$19,271.00
United Facility/Professional Professional Modifier Low / Median / High Price $2,130.23 / $2,964.58 / $5,021.26	Professional		$2,130.23	$2,964.58	$5,021.26
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $1,390.83 / $1,390.83 / $1,771.02	Professional		$1,390.83	$1,390.83	$1,771.02