Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $3,460.95 / $7,856.36 / $8,202.45	Facility		$3,460.95	$7,856.36	$8,202.45
Aetna Facility/Professional Professional Modifier Low / Median / High Price $2,272.91 / $3,460.95 / $8,202.45	Professional		$2,272.91	$3,460.95	$8,202.45
Asuris Northwest Health Facility/Professional Facility Modifier Low / Median / High Price $4,663.39 / $9,621.70 / $21,140.73	Facility		$4,663.39	$9,621.70	$21,140.73
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $3,144.90 / $4,526.88 / $26,362.41	Professional		$3,144.90	$4,526.88	$26,362.41
Cigna Facility/Professional Facility Modifier Low / Median / High Price $2,550.04 / $2,550.04 / $2,550.04	Facility		$2,550.04	$2,550.04	$2,550.04
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,861.53 / $1,861.53 / $2,550.04	Professional		$1,861.53	$1,861.53	$2,550.04
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $2,567.56 / $5,059.45 / $11,684.06	Facility		$2,567.56	$5,059.45	$11,684.06
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $2,570.38 / $5,059.45 / $8,659.78	Professional		$2,570.38	$5,059.45	$8,659.78
Molina Facility/Professional Professional Modifier Low / Median / High Price $3,674.46 / $4,082.74 / $4,491.01	Professional		$3,674.46	$4,082.74	$4,491.01
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $4,227.45 / $4,793.17 / $5,325.74	Facility		$4,227.45	$4,793.17	$5,325.74
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $4,545.81 / $5,325.74 / $5,325.74	Professional		$4,545.81	$5,325.74	$5,325.74
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $4,663.39 / $5,981.06 / $10,401.84	Facility		$4,663.39	$5,981.06	$10,401.84
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $5,069.12 / $5,200.92 / $5,200.92	Facility		$5,069.12	$5,200.92	$5,200.92
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $4,230.82 / $4,526.88 / $5,858.31	Professional		$4,230.82	$4,526.88	$5,858.31
United Facility/Professional Facility Modifier Low / Median / High Price $5,441.30 / $6,529.56 / $6,529.56	Facility		$5,441.30	$6,529.56	$6,529.56
United Facility/Professional Professional Modifier Low / Median / High Price $2,035.96 / $3,066.88 / $3,884.34	Professional		$2,035.96	$3,066.88	$3,884.34
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $2,192.92 / $2,192.92 / $2,469.21	Professional		$2,192.92	$2,192.92	$2,469.21