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 $1,153.89 / $1,584.58 / $3,492.20	Professional		$1,153.89	$1,584.58	$3,492.20
Asuris Northwest Health Facility/Professional Facility Modifier Low / Median / High Price $1,717.86 / $18,220.34 / $35,644.43	Facility		$1,717.86	$18,220.34	$35,644.43
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $1,788.10 / $2,896.89 / $10,943.18	Professional		$1,788.10	$2,896.89	$10,943.18
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 $1,248.26 / $2,235.21 / $3,781.77	Professional		$1,248.26	$2,235.21	$3,781.77
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $1,186.84 / $2,414.41 / $3,308.82	Facility		$1,186.84	$2,414.41	$3,308.82
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $1,154.59 / $2,327.52 / $3,069.14	Professional		$1,154.59	$2,327.52	$3,069.14
Molina Facility/Professional Professional Modifier Low / Median / High Price $156.75 / $722.49 / $2,475.00	Professional		$156.75	$722.49	$2,475.00
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $1,720.94 / $2,379.84 / $2,518.53	Facility		$1,720.94	$2,379.84	$2,518.53
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $1,675.65 / $1,675.65 / $1,717.86	Facility		$1,675.65	$1,675.65	$1,717.86
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $1,919.56 / $2,737.26 / $3,409.79	Professional		$1,919.56	$2,737.26	$3,409.79
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 $1,708.94 / $2,445.16 / $3,255.29	Professional		$1,708.94	$2,445.16	$3,255.29
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 $1,449.00 / $2,031.37 / $3,580.82	Professional		$1,449.00	$2,031.37	$3,580.82
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $1,046.29 / $1,046.29 / $1,344.04	Professional		$1,046.29	$1,046.29	$1,344.04