Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $1,621.30 / $3,680.35 / $3,842.48	Facility		$1,621.30	$3,680.35	$3,842.48
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,278.04 / $1,621.30 / $3,842.48	Professional		$1,278.04	$1,621.30	$3,842.48
Asuris Northwest Health Facility/Professional Facility Modifier Low / Median / High Price $2,184.60 / $4,750.97 / $11,750.92	Facility		$2,184.60	$4,750.97	$11,750.92
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $1,596.91 / $2,170.54 / $13,013.65	Professional		$1,596.91	$2,170.54	$13,013.65
Cigna Facility/Professional Facility Modifier Low / Median / High Price $1,747.16 / $1,747.16 / $1,747.16	Facility		$1,747.16	$1,747.16	$1,747.16
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,275.43 / $1,275.43 / $1,747.16	Professional		$1,275.43	$1,275.43	$1,747.16
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $1,422.33 / $2,494.87 / $6,472.50	Facility		$1,422.33	$2,494.87	$6,472.50
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $1,423.89 / $2,499.86 / $4,796.18	Professional		$1,423.89	$2,499.86	$4,796.18
Molina Facility/Professional Professional Modifier Low / Median / High Price $1,721.33 / $1,912.59 / $2,103.84	Professional		$1,721.33	$1,912.59	$2,103.84
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $1,980.39 / $2,436.40 / $2,556.07	Facility		$1,980.39	$2,436.40	$2,556.07
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $2,494.87 / $2,556.07 / $2,556.07	Professional		$2,494.87	$2,556.07	$2,556.07
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $2,184.60 / $2,801.86 / $4,872.80	Facility		$2,184.60	$2,801.86	$4,872.80
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $2,374.66 / $2,436.40 / $2,436.40	Facility		$2,374.66	$2,436.40	$2,436.40
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $1,981.96 / $2,120.64 / $2,744.36	Professional		$1,981.96	$2,120.64	$2,744.36
United Facility/Professional Professional Modifier Low / Median / High Price $1,127.77 / $1,691.66 / $2,151.65	Professional		$1,127.77	$1,691.66	$2,151.65
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $1,415.61 / $1,415.61 / $2,120.64	Professional		$1,415.61	$1,415.61	$2,120.64