Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $2,874.18 / $2,902.70 / $4,540.77	Professional		$2,874.18	$2,902.70	$4,540.77
Asuris Northwest Health Facility/Professional Facility Modifier Low / Median / High Price $4,887.42 / $30,467.00 / $30,467.00	Facility		$4,887.42	$30,467.00	$30,467.00
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $3,255.34 / $4,316.60 / $5,851.50	Professional		$3,255.34	$4,316.60	$5,851.50
Cigna Facility/Professional Facility Modifier Low / Median / High Price $3,282.89 / $3,282.89 / $3,282.89	Facility		$3,282.89	$3,282.89	$3,282.89
Cigna Facility/Professional Professional Modifier Low / Median / High Price $498.23 / $2,790.46 / $3,888.00	Professional		$498.23	$2,790.46	$3,888.00
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $5,805.40 / $5,805.40 / $5,805.40	Facility		$5,805.40	$5,805.40	$5,805.40
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $5,805.40 / $5,805.40 / $5,805.40	Professional		$5,805.40	$5,805.40	$5,805.40
Molina Facility/Professional Professional Modifier Low / Median / High Price $540.44 / $4,494.87 / $4,944.35	Professional		$540.44	$4,494.87	$4,944.35
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $5,752.96 / $10,471.70 / $11,532.71	Facility		$5,752.96	$10,471.70	$11,532.71
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $9,467.15 / $11,371.25 / $11,532.71	Professional		$9,467.15	$11,371.25	$11,532.71
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $504.53 / $504.53 / $504.53	Facility		$504.53	$504.53	$504.53
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $1,017.37 / $4,790.93 / $5,636.40	Professional		$1,017.37	$4,790.93	$5,636.40
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $395.92 / $395.92 / $482.07	Professional		$395.92	$395.92	$482.07
United Facility/Professional Professional Modifier Low / Median / High Price $2,688.62 / $2,859.96 / $5,499.30	Professional		$2,688.62	$2,859.96	$5,499.30
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $4,179.59 / $4,179.59 / $4,179.59	Professional		$4,179.59	$4,179.59	$4,179.59