Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,596.86 / $2,274.48 / $3,593.25	Professional		$1,596.86	$2,274.48	$3,593.25
Asuris Northwest Health Facility/Professional Facility Modifier Low / Median / High Price $399.25 / $24,693.27 / $24,693.27	Facility		$399.25	$24,693.27	$24,693.27
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $2,672.90 / $3,593.34 / $4,634.50	Professional		$2,672.90	$3,593.34	$4,634.50
Cigna Facility/Professional Facility Modifier Low / Median / High Price $2,200.00 / $2,200.00 / $2,244.00	Facility		$2,200.00	$2,200.00	$2,244.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,870.00 / $2,200.00 / $4,104.00	Professional		$1,870.00	$2,200.00	$4,104.00
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $4,512.60 / $4,512.60 / $4,512.60	Facility		$4,512.60	$4,512.60	$4,512.60
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $4,512.60 / $4,512.60 / $4,512.60	Professional		$4,512.60	$4,512.60	$4,512.60
Molina Facility/Professional Professional Modifier Low / Median / High Price $449.88 / $3,741.69 / $4,115.85	Professional		$449.88	$3,741.69	$4,115.85
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $4,789.01 / $5,523.10 / $6,728.14	Facility		$4,789.01	$5,523.10	$6,728.14
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $5,523.10 / $6,728.14 / $6,728.14	Professional		$5,523.10	$6,728.14	$6,728.14
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $399.25 / $399.25 / $399.25	Facility		$399.25	$399.25	$399.25
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $805.03 / $3,723.94 / $4,381.10	Professional		$805.03	$3,723.94	$4,381.10
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $329.58 / $329.58 / $401.30	Professional		$329.58	$329.58	$401.30
United Facility/Professional Professional Modifier Low / Median / High Price $2,220.36 / $2,405.39 / $4,351.50	Professional		$2,220.36	$2,405.39	$4,351.50
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $3,530.61 / $3,530.61 / $3,530.61	Professional		$3,530.61	$3,530.61	$3,530.61