Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $2,185.17 / $4,161.00 / $5,178.85	Facility		$2,185.17	$4,161.00	$5,178.85
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,389.25 / $2,185.17 / $5,178.85	Professional		$1,389.25	$2,185.17	$5,178.85
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $2,521.92 / $2,521.92 / $2,577.78	Professional		$2,521.92	$2,521.92	$2,577.78
Asuris Northwest Health Facility/Professional Facility Modifier Low / Median / High Price $2,944.38 / $6,403.31 / $14,785.52	Facility		$2,944.38	$6,403.31	$14,785.52
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $2,350.21 / $2,891.80 / $17,561.62	Professional		$2,350.21	$2,891.80	$17,561.62
Cigna Facility/Professional Facility Modifier Low / Median / High Price $1,721.98 / $1,721.98 / $1,721.98	Facility		$1,721.98	$1,721.98	$1,721.98
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,257.05 / $1,257.05 / $1,721.98	Professional		$1,257.05	$1,257.05	$1,721.98
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $1,734.00 / $3,307.13 / $7,890.00	Facility		$1,734.00	$3,307.13	$7,890.00
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $1,735.91 / $3,221.73 / $5,847.11	Professional		$1,735.91	$3,221.73	$5,847.11
Molina Facility/Professional Professional Modifier Low / Median / High Price $2,320.00 / $2,577.78 / $2,835.55	Professional		$2,320.00	$2,577.78	$2,835.55
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $2,669.13 / $3,026.30 / $3,362.56	Facility		$2,669.13	$3,026.30	$3,362.56
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $2,778.50 / $3,362.56 / $3,698.82	Professional		$2,778.50	$3,362.56	$3,698.82
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $2,944.38 / $3,776.31 / $6,567.50	Facility		$2,944.38	$3,776.31	$6,567.50
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $3,200.54 / $3,283.75 / $3,283.75	Facility		$3,200.54	$3,283.75	$3,283.75
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $2,671.27 / $2,858.18 / $3,698.82	Professional		$2,671.27	$2,858.18	$3,698.82
United Facility/Professional Facility Modifier Low / Median / High Price $3,674.38 / $4,409.26 / $4,409.26	Facility		$3,674.38	$4,409.26	$4,409.26
United Facility/Professional Professional Modifier Low / Median / High Price $1,374.83 / $2,068.92 / $2,623.00	Professional		$1,374.83	$2,068.92	$2,623.00
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $1,563.41 / $1,563.41 / $1,972.92	Professional		$1,563.41	$1,563.41	$1,972.92