Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $1,773.79 / $5,132.00 / $22,024.00	Facility		$1,773.79	$5,132.00	$22,024.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,292.14 / $1,773.79 / $3,972.30	Professional		$1,292.14	$1,773.79	$3,972.30
Asuris Northwest Health Facility/Professional Facility Modifier Low / Median / High Price $1,923.97 / $18,220.34 / $35,644.43	Facility		$1,923.97	$18,220.34	$35,644.43
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $1,982.74 / $3,182.08 / $12,255.68	Professional		$1,982.74	$3,182.08	$12,255.68
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 $1,465.54 / $2,501.57 / $4,232.53	Professional		$1,465.54	$2,501.57	$4,232.53
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $1,333.31 / $2,575.60 / $3,856.70	Facility		$1,333.31	$2,575.60	$3,856.70
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $1,333.31 / $2,494.58 / $3,545.77	Professional		$1,333.31	$2,494.58	$3,545.77
Molina Facility/Professional Professional Modifier Low / Median / High Price $157.37 / $816.99 / $2,719.62	Professional		$157.37	$816.99	$2,719.62
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $2,003.12 / $2,710.82 / $2,820.70	Facility		$2,003.12	$2,710.82	$2,820.70
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $1,878.14 / $1,878.14 / $1,923.97	Facility		$1,878.14	$1,878.14	$1,923.97
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $2,148.71 / $3,068.04 / $3,818.89	Professional		$2,148.71	$3,068.04	$3,818.89
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 $1,915.45 / $2,738.52 / $3,645.86	Professional		$1,915.45	$2,738.52	$3,645.86
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 $1,620.40 / $2,228.04 / $4,003.41	Professional		$1,620.40	$2,228.04	$4,003.41
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $1,171.34 / $1,171.34 / $1,502.78	Professional		$1,171.34	$1,171.34	$1,502.78