Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $2,790.00 / $6,333.30 / $6,612.30	Facility		$2,790.00	$6,333.30	$6,612.30
Aetna Facility/Professional Professional Modifier Low / Median / High Price $2,025.09 / $2,790.00 / $6,612.30	Professional		$2,025.09	$2,790.00	$6,612.30
Asuris Northwest Health Facility/Professional Facility Modifier Low / Median / High Price $3,759.34 / $8,175.67 / $17,548.22	Facility		$3,759.34	$8,175.67	$17,548.22
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $2,639.34 / $3,649.28 / $21,251.69	Professional		$2,639.34	$3,649.28	$21,251.69
Cigna Facility/Professional Facility Modifier Low / Median / High Price $2,637.76 / $2,637.76 / $2,637.76	Facility		$2,637.76	$2,637.76	$2,637.76
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,925.56 / $1,925.56 / $2,637.76	Professional		$1,925.56	$1,925.56	$2,637.76
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $2,085.71 / $4,078.61 / $9,491.25	Facility		$2,085.71	$4,078.61	$9,491.25
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $2,088.01 / $4,078.61 / $7,034.57	Professional		$2,088.01	$4,078.61	$7,034.57
Molina Facility/Professional Professional Modifier Low / Median / High Price $2,962.13 / $3,291.26 / $3,620.38	Professional		$2,962.13	$3,291.26	$3,620.38
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $3,407.91 / $4,050.18 / $4,293.27	Facility		$3,407.91	$4,050.18	$4,293.27
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $3,410.63 / $4,293.27 / $4,293.27	Professional		$3,410.63	$4,293.27	$4,293.27
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $3,759.34 / $4,821.55 / $8,385.29	Facility		$3,759.34	$4,821.55	$8,385.29
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $4,086.40 / $4,192.64 / $4,192.64	Facility		$4,086.40	$4,192.64	$4,192.64
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $3,410.63 / $3,649.28 / $4,722.60	Professional		$3,410.63	$3,649.28	$4,722.60
United Facility/Professional Professional Modifier Low / Median / High Price $1,653.86 / $2,372.67 / $3,155.34	Professional		$1,653.86	$2,372.67	$3,155.34
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $1,342.64 / $1,342.64 / $2,025.27	Professional		$1,342.64	$1,342.64	$2,025.27