Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $1,516.10 / $3,441.55 / $3,593.16	Facility		$1,516.10	$3,441.55	$3,593.16
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,043.95 / $1,516.10 / $3,593.16	Professional		$1,043.95	$1,516.10	$3,593.16
Asuris Northwest Health Facility/Professional Facility Modifier Low / Median / High Price $2,042.85 / $4,442.72 / $11,048.78	Facility		$2,042.85	$4,442.72	$11,048.78
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $1,633.10 / $2,029.71 / $13,780.11	Professional		$1,633.10	$2,029.71	$13,780.11
Cigna Facility/Professional Facility Modifier Low / Median / High Price $1,606.19 / $1,606.19 / $1,606.19	Facility		$1,606.19	$1,606.19	$1,606.19
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,172.52 / $1,172.52 / $1,606.19	Professional		$1,172.52	$1,172.52	$1,606.19
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $1,313.58 / $2,333.00 / $5,978.43	Facility		$1,313.58	$2,333.00	$5,978.43
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $1,315.02 / $2,333.00 / $4,430.43	Professional		$1,315.02	$2,333.00	$4,430.43
Molina Facility/Professional Professional Modifier Low / Median / High Price $1,609.64 / $1,788.49 / $1,967.33	Professional		$1,609.64	$1,788.49	$1,967.33
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $2,038.96 / $2,278.32 / $2,333.00	Facility		$2,038.96	$2,278.32	$2,333.00
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $1,661.36 / $1,853.36 / $2,333.00	Professional		$1,661.36	$1,853.36	$2,333.00
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $2,042.85 / $2,620.07 / $4,556.64	Facility		$2,042.85	$2,620.07	$4,556.64
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $2,220.58 / $2,278.32 / $2,278.32	Facility		$2,220.58	$2,278.32	$2,278.32
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $1,853.36 / $1,983.05 / $2,566.30	Professional		$1,853.36	$1,983.05	$2,566.30
United Facility/Professional Professional Modifier Low / Median / High Price $1,041.63 / $1,388.84 / $1,987.29	Professional		$1,041.63	$1,388.84	$1,987.29
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $690.06 / $690.06 / $1,275.56	Professional		$690.06	$690.06	$1,275.56