Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $1,733.00 / $5,132.00 / $22,024.00	Facility		$1,733.00	$5,132.00	$22,024.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,099.22 / $1,624.04 / $3,389.04	Professional		$1,099.22	$1,624.04	$3,389.04
Asuris Northwest Health Facility/Professional Facility Modifier Low / Median / High Price $1,761.74 / $18,220.34 / $35,644.43	Facility		$1,761.74	$18,220.34	$35,644.43
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $1,813.39 / $2,923.31 / $11,680.42	Professional		$1,813.39	$2,923.31	$11,680.42
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 $1,343.97 / $2,270.48 / $3,882.16	Professional		$1,343.97	$2,270.48	$3,882.16
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $1,233.57 / $2,528.81 / $3,524.92	Facility		$1,233.57	$2,528.81	$3,524.92
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $1,218.60 / $2,472.78 / $3,219.91	Professional		$1,218.60	$2,472.78	$3,219.91
Molina Facility/Professional Professional Modifier Low / Median / High Price $156.38 / $721.85 / $2,518.90	Professional		$156.38	$721.85	$2,518.90
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $1,813.48 / $2,458.90 / $2,582.85	Facility		$1,813.48	$2,458.90	$2,582.85
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $1,719.14 / $1,719.14 / $1,761.74	Facility		$1,719.14	$1,719.14	$1,761.74
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $1,950.90 / $2,808.30 / $3,496.87	Professional		$1,950.90	$2,808.30	$3,496.87
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 $1,753.29 / $2,507.60 / $3,338.43	Professional		$1,753.29	$2,507.60	$3,338.43
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 $1,551.48 / $2,088.35 / $3,666.01	Professional		$1,551.48	$2,088.35	$3,666.01
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $1,073.08 / $1,073.08 / $1,379.77	Professional		$1,073.08	$1,073.08	$1,379.77