Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $2,166.88 / $2,166.88 / $2,166.88	Facility		$2,166.88	$2,166.88	$2,166.88
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,969.89 / $2,028.98 / $2,166.88	Professional		$1,969.89	$2,028.98	$2,166.88
Asuris Northwest Health Facility/Professional Facility Modifier Low / Median / High Price $1,969.89 / $2,566.14 / $4,051.80	Facility		$1,969.89	$2,566.14	$4,051.80
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $1,871.40 / $1,969.89 / $12,155.40	Professional		$1,871.40	$1,969.89	$12,155.40
Cigna Facility/Professional Facility Modifier Low / Median / High Price $1,858.38 / $1,858.38 / $4,592.04	Facility		$1,858.38	$1,858.38	$4,592.04
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,969.89 / $1,969.89 / $2,415.90	Professional		$1,969.89	$1,969.89	$2,415.90
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $1,969.89 / $1,969.89 / $2,659.35	Facility		$1,969.89	$1,969.89	$2,659.35
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $1,969.89 / $1,969.89 / $2,462.36	Professional		$1,969.89	$1,969.89	$2,462.36
Molina Facility/Professional Professional Modifier Low / Median / High Price $30.00 / $30.00 / $30.00	Professional		$30.00	$30.00	$30.00
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $1,789.55 / $1,969.89 / $3,723.09	Facility		$1,789.55	$1,969.89	$3,723.09
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $2,242.00 / $2,242.00 / $2,296.02	Facility		$2,242.00	$2,242.00	$2,296.02
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $2,079.92 / $2,296.02 / $2,431.08	Professional		$2,079.92	$2,296.02	$2,431.08
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $1,969.89 / $1,969.89 / $1,969.89	Facility		$1,969.89	$1,969.89	$1,969.89
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $1,871.40 / $1,969.89 / $1,969.89	Professional		$1,871.40	$1,969.89	$1,969.89
United Facility/Professional Facility Modifier Low / Median / High Price $2,251.00 / $2,251.00 / $2,251.00	Facility		$2,251.00	$2,251.00	$2,251.00
United Facility/Professional Professional Modifier Low / Median / High Price $1,969.89 / $1,969.89 / $2,363.87	Professional		$1,969.89	$1,969.89	$2,363.87
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $550.79 / $1,969.89 / $1,969.89	Professional		$550.79	$1,969.89	$1,969.89