Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $1,761.02 / $3,997.52 / $4,173.62	Facility		$1,761.02	$3,997.52	$4,173.62
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,406.30 / $1,761.02 / $4,173.62	Professional		$1,406.30	$1,761.02	$4,173.62
Asuris Northwest Health Facility/Professional Facility Modifier Low / Median / High Price $2,372.86 / $5,160.39 / $12,494.15	Facility		$2,372.86	$5,160.39	$12,494.15
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $1,896.91 / $2,357.59 / $15,222.86	Professional		$1,896.91	$2,357.59	$15,222.86
Cigna Facility/Professional Facility Modifier Low / Median / High Price $1,486.28 / $1,486.28 / $1,486.28	Facility		$1,486.28	$1,486.28	$1,486.28
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,084.98 / $1,084.98 / $1,486.28	Professional		$1,084.98	$1,084.98	$1,486.28
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $1,496.49 / $2,709.87 / $6,810.00	Facility		$1,496.49	$2,709.87	$6,810.00
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $1,498.13 / $2,709.87 / $5,046.92	Professional		$1,498.13	$2,709.87	$5,046.92
Molina Facility/Professional Professional Modifier Low / Median / High Price $1,869.66 / $2,077.40 / $2,285.14	Professional		$1,869.66	$2,077.40	$2,285.14
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $2,151.03 / $2,646.36 / $2,812.59	Facility		$2,151.03	$2,646.36	$2,812.59
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $2,574.38 / $2,709.87 / $2,812.59	Professional		$2,574.38	$2,709.87	$2,812.59
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $2,372.86 / $3,043.31 / $5,292.72	Facility		$2,372.86	$3,043.31	$5,292.72
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $2,579.30 / $2,646.36 / $2,646.36	Facility		$2,579.30	$2,646.36	$2,646.36
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $2,152.75 / $2,303.39 / $2,980.86	Professional		$2,152.75	$2,303.39	$2,980.86
United Facility/Professional Facility Modifier Low / Median / High Price $1,428.89 / $1,428.89 / $1,428.89	Facility		$1,428.89	$1,428.89	$1,428.89
United Facility/Professional Professional Modifier Low / Median / High Price $1,186.65 / $1,779.98 / $2,263.96	Professional		$1,186.65	$1,779.98	$2,263.96
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $565.69 / $565.69 / $1,556.88	Professional		$565.69	$565.69	$1,556.88