Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $1,773.31 / $4,025.41 / $4,202.74	Facility		$1,773.31	$4,025.41	$4,202.74
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,542.27 / $1,773.31 / $4,202.74	Professional		$1,542.27	$1,773.31	$4,202.74
Asuris Northwest Health Facility/Professional Facility Modifier Low / Median / High Price $2,389.42 / $5,196.43 / $12,904.54	Facility		$2,389.42	$5,196.43	$12,904.54
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $1,910.16 / $2,389.42 / $15,361.01	Professional		$1,910.16	$2,389.42	$15,361.01
Cigna Facility/Professional Facility Modifier Low / Median / High Price $1,769.38 / $1,769.38 / $1,769.38	Facility		$1,769.38	$1,769.38	$1,769.38
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,291.65 / $1,291.65 / $1,769.38	Professional		$1,291.65	$1,291.65	$1,769.38
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $1,526.07 / $2,728.80 / $6,944.06	Facility		$1,526.07	$2,728.80	$6,944.06
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $1,527.74 / $2,728.80 / $5,146.22	Professional		$1,527.74	$2,728.80	$5,146.22
Molina Facility/Professional Professional Modifier Low / Median / High Price $1,882.71 / $2,091.91 / $2,301.10	Professional		$1,882.71	$2,091.91	$2,301.10
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $2,166.04 / $2,664.84 / $3,084.54	Facility		$2,166.04	$2,664.84	$3,084.54
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $2,592.36 / $2,728.80 / $3,084.54	Professional		$2,592.36	$2,728.80	$3,084.54
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $2,389.42 / $3,064.57 / $5,329.68	Facility		$2,389.42	$3,064.57	$5,329.68
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $2,597.31 / $2,664.84 / $2,664.84	Facility		$2,597.31	$2,664.84	$2,664.84
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $2,167.78 / $2,319.48 / $3,001.68	Professional		$2,167.78	$2,319.48	$3,001.68
United Facility/Professional Professional Modifier Low / Median / High Price $1,209.93 / $1,814.90 / $2,308.39	Professional		$1,209.93	$1,814.90	$2,308.39
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $1,481.65 / $1,481.65 / $1,481.65	Professional		$1,481.65	$1,481.65	$1,481.65