Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $2,052.89 / $4,660.06 / $4,865.35	Facility		$2,052.89	$4,660.06	$4,865.35
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,470.81 / $2,052.89 / $4,865.35	Professional		$1,470.81	$2,052.89	$4,865.35
Asuris Northwest Health Facility/Professional Facility Modifier Low / Median / High Price $2,663.69 / $5,792.88 / $12,562.85	Facility		$2,663.69	$5,792.88	$12,562.85
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $1,847.95 / $2,585.71 / $15,057.95	Professional		$1,847.95	$2,585.71	$15,057.95
Cigna Facility/Professional Facility Modifier Low / Median / High Price $1,638.80 / $1,638.80 / $1,638.80	Facility		$1,638.80	$1,638.80	$1,638.80
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,196.32 / $1,196.32 / $1,638.80	Professional		$1,196.32	$1,196.32	$1,638.80
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $1,606.28 / $2,920.40 / $7,878.18	Facility		$1,606.28	$2,920.40	$7,878.18
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $1,615.20 / $2,920.40 / $5,163.60	Professional		$1,615.20	$2,920.40	$5,163.60
Molina Facility/Professional Professional Modifier Low / Median / High Price $2,098.82 / $2,332.03 / $2,565.23	Professional		$2,098.82	$2,332.03	$2,565.23
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $2,414.69 / $2,737.81 / $3,042.01	Facility		$2,414.69	$2,737.81	$3,042.01
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $2,626.45 / $3,042.01 / $3,042.01	Professional		$2,626.45	$3,042.01	$3,042.01
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $2,663.69 / $3,416.32 / $5,941.42	Facility		$2,663.69	$3,416.32	$5,941.42
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $2,895.43 / $2,970.71 / $2,970.71	Facility		$2,895.43	$2,970.71	$2,970.71
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $2,416.61 / $2,585.71 / $3,346.21	Professional		$2,416.61	$2,585.71	$3,346.21
United Facility/Professional Facility Modifier Low / Median / High Price $19.39 / $1,203.23 / $1,214.06	Facility		$19.39	$1,203.23	$1,214.06
United Facility/Professional Professional Modifier Low / Median / High Price $1,122.50 / $1,216.04 / $2,316.27	Professional		$1,122.50	$1,216.04	$2,316.27
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $1,248.97 / $1,248.97 / $1,482.13	Professional		$1,248.97	$1,248.97	$1,482.13