Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $3,947.40 / $6,829.00 / $9,355.34	Facility		$3,947.40	$6,829.00	$9,355.34
Aetna Facility/Professional Professional Modifier Low / Median / High Price $3,761.64 / $3,947.40 / $3,993.84	Professional		$3,761.64	$3,947.40	$3,993.84
Asuris Northwest Health Facility/Professional Facility Modifier Low / Median / High Price $4,411.80 / $4,411.80 / $35,376.98	Facility		$4,411.80	$4,411.80	$35,376.98
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $4,411.80 / $4,411.80 / $55,163.33	Professional		$4,411.80	$4,411.80	$55,163.33
Cigna Facility/Professional Facility Modifier Low / Median / High Price $3,947.40 / $3,947.40 / $7,894.80	Facility		$3,947.40	$3,947.40	$7,894.80
Cigna Facility/Professional Professional Modifier Low / Median / High Price $3,947.40 / $3,947.40 / $3,947.40	Professional		$3,947.40	$3,947.40	$3,947.40
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $5,944.56 / $14,827.52 / $17,631.08	Facility		$5,944.56	$14,827.52	$17,631.08
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $5,944.56 / $14,827.52 / $19,164.55	Professional		$5,944.56	$14,827.52	$19,164.55
Molina Facility/Professional Professional Modifier Low / Median / High Price $75.00 / $4,852.97 / $7,117.70	Professional		$75.00	$4,852.97	$7,117.70
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $4,411.80 / $4,411.80 / $12,696.50	Facility		$4,411.80	$4,411.80	$12,696.50
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $4,411.80 / $4,411.80 / $4,411.80	Facility		$4,411.80	$4,411.80	$4,411.80
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $4,411.80 / $4,411.80 / $4,411.80	Professional		$4,411.80	$4,411.80	$4,411.80
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $4,411.80 / $4,411.80 / $4,411.80	Facility		$4,411.80	$4,411.80	$4,411.80
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $4,191.21 / $4,411.80 / $4,411.80	Professional		$4,191.21	$4,411.80	$4,411.80
United Facility/Professional Professional Modifier Low / Median / High Price $3,870.00 / $3,870.00 / $4,644.00	Professional		$3,870.00	$3,870.00	$4,644.00