Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $5,508.29 / $12,503.80 / $13,054.60	Facility		$5,508.29	$12,503.80	$13,054.60
Aetna Facility/Professional Professional Modifier Low / Median / High Price $4,389.80 / $5,508.29 / $13,054.60	Professional		$4,389.80	$5,508.29	$13,054.60
Asuris Northwest Health Facility/Professional Facility Modifier Low / Median / High Price $7,422.07 / $16,141.22 / $40,507.83	Facility		$7,422.07	$16,141.22	$40,507.83
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $6,036.09 / $7,417.70 / $43,722.41	Professional		$6,036.09	$7,417.70	$43,722.41
Cigna Facility/Professional Facility Modifier Low / Median / High Price $6,042.00 / $6,042.00 / $6,042.00	Facility		$6,042.00	$6,042.00	$6,042.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $4,410.66 / $4,410.66 / $6,042.00	Professional		$4,410.66	$4,410.66	$6,042.00
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $4,881.24 / $8,476.20 / $22,212.18	Facility		$4,881.24	$8,476.20	$22,212.18
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $4,886.60 / $8,579.18 / $16,463.11	Professional		$4,886.60	$8,579.18	$16,463.11
Molina Facility/Professional Professional Modifier Low / Median / High Price $60.00 / $8,476.20 / $8,476.20	Professional		$60.00	$8,476.20	$8,476.20
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $6,728.23 / $8,277.54 / $8,779.60	Facility		$6,728.23	$8,277.54	$8,779.60
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $7,628.59 / $8,476.20 / $8,779.60	Professional		$7,628.59	$8,476.20	$8,779.60
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $7,422.07 / $9,519.18 / $16,555.09	Facility		$7,422.07	$9,519.18	$16,555.09
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $8,067.79 / $8,277.54 / $8,277.54	Facility		$8,067.79	$8,277.54	$8,277.54
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $6,733.60 / $7,204.78 / $9,323.83	Professional		$6,733.60	$7,204.78	$9,323.83
United Facility/Professional Professional Modifier Low / Median / High Price $3,870.38 / $5,831.47 / $7,384.18	Professional		$3,870.38	$5,831.47	$7,384.18
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $4,587.08 / $4,587.08 / $5,217.74	Professional		$4,587.08	$4,587.08	$5,217.74