Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $3,312.50 / $7,519.38 / $7,850.62	Facility		$3,312.50	$7,519.38	$7,850.62
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,911.49 / $3,312.50 / $7,850.62	Professional		$1,911.49	$3,312.50	$7,850.62
Asuris Northwest Health Facility/Professional Facility Modifier Low / Median / High Price $4,463.39 / $9,706.81 / $19,929.31	Facility		$4,463.39	$9,706.81	$19,929.31
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $2,950.95 / $4,332.71 / $30,066.71	Professional		$2,950.95	$4,332.71	$30,066.71
Cigna Facility/Professional Facility Modifier Low / Median / High Price $3,297.39 / $3,297.39 / $3,297.39	Facility		$3,297.39	$3,297.39	$3,297.39
Cigna Facility/Professional Professional Modifier Low / Median / High Price $2,407.09 / $2,407.09 / $3,297.39	Professional		$2,407.09	$2,407.09	$3,297.39
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $2,537.28 / $5,097.31 / $13,967.93	Facility		$2,537.28	$5,097.31	$13,967.93
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $2,680.88 / $4,883.82 / $8,111.98	Professional		$2,680.88	$4,883.82	$8,111.98
Molina Facility/Professional Professional Modifier Low / Median / High Price $3,516.87 / $3,907.64 / $4,298.40	Professional		$3,516.87	$3,907.64	$4,298.40
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $3,733.38 / $4,977.85 / $5,097.31	Facility		$3,733.38	$4,977.85	$5,097.31
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $4,049.37 / $4,049.37 / $4,049.37	Professional		$4,049.37	$4,049.37	$4,049.37
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $4,463.39 / $5,724.53 / $9,955.70	Facility		$4,463.39	$5,724.53	$9,955.70
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $4,851.70 / $4,977.85 / $4,977.85	Facility		$4,851.70	$4,977.85	$4,977.85
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $4,049.37 / $4,332.71 / $5,607.04	Professional		$4,049.37	$4,332.71	$5,607.04
United Facility/Professional Facility Modifier Low / Median / High Price $5,097.31 / $6,116.77 / $6,116.77	Facility		$5,097.31	$6,116.77	$6,116.77
United Facility/Professional Professional Modifier Low / Median / High Price $1,907.24 / $2,860.87 / $3,638.78	Professional		$1,907.24	$2,860.87	$3,638.78
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $2,335.56 / $4,332.71 / $4,332.71	Professional		$2,335.56	$4,332.71	$4,332.71