Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $821.69 / $1,605.03 / $19,900.00	Facility		$821.69	$1,605.03	$19,900.00
Aetna Facility/Professional Facility Modifier 50 Low / Median / High Price $4,792.12 / $7,639.00 / $9,313.20	Facility	50	$4,792.12	$7,639.00	$9,313.20
Aetna Facility/Professional Professional Modifier Low / Median / High Price $505.04 / $719.72 / $1,519.90	Professional		$505.04	$719.72	$1,519.90
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $252.52 / $889.83 / $4,142.00	Professional	50	$252.52	$889.83	$4,142.00
Asuris Northwest Health Facility/Professional Facility Modifier Low / Median / High Price $1,040.51 / $5,167.93 / $11,429.12	Facility		$1,040.51	$5,167.93	$11,429.12
Asuris Northwest Health Facility/Professional Facility Modifier 50 Low / Median / High Price $5,921.24 / $7,751.91 / $14,996.88	Facility	50	$5,921.24	$7,751.91	$14,996.88
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $758.64 / $1,383.88 / $4,709.39	Professional		$758.64	$1,383.88	$4,709.39
Asuris Northwest Health Facility/Professional Professional Modifier 50 Low / Median / High Price $1,461.00 / $1,600.08 / $1,651.34	Professional	50	$1,461.00	$1,600.08	$1,651.34
Cigna Facility/Professional Facility Modifier Low / Median / High Price $906.70 / $1,413.00 / $2,323.83	Facility		$906.70	$1,413.00	$2,323.83
Cigna Facility/Professional Professional Modifier Low / Median / High Price $642.66 / $1,003.52 / $1,811.70	Professional		$642.66	$1,003.52	$1,811.70
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $758.20 / $1,172.85 / $1,723.12	Facility		$758.20	$1,172.85	$1,723.12
Kaiser Permanente Facility/Professional Facility Modifier 50 Low / Median / High Price $5,429.81 / $5,601.66 / $13,064.10	Facility	50	$5,429.81	$5,601.66	$13,064.10
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $763.50 / $1,191.57 / $1,739.78	Professional		$763.50	$1,191.57	$1,739.78
Molina Facility/Professional Professional Modifier Low / Median / High Price $70.96 / $297.73 / $1,246.27	Professional		$70.96	$297.73	$1,246.27
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $833.82 / $1,153.07 / $1,252.90	Facility		$833.82	$1,153.07	$1,252.90
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $759.83 / $854.59 / $1,040.51	Facility		$759.83	$854.59	$1,040.51
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $776.44 / $1,259.32 / $1,579.55	Professional		$776.44	$1,259.32	$1,579.55
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $3,770.96 / $5,167.93 / $9,885.68	Facility		$3,770.96	$5,167.93	$9,885.68
Regence BlueShield Facility/Professional Facility Modifier 50 Low / Median / High Price $5,656.44 / $7,751.91 / $14,828.52	Facility	50	$5,656.44	$7,751.91	$14,828.52
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $736.04 / $1,074.58 / $1,497.33	Professional		$736.04	$1,074.58	$1,497.33
United Facility/Professional Facility Modifier Low / Median / High Price $629.00 / $1,120.00 / $6,857.00	Facility		$629.00	$1,120.00	$6,857.00
United Facility/Professional Professional Modifier Low / Median / High Price $752.35 / $944.24 / $1,788.10	Professional		$752.35	$944.24	$1,788.10
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $604.23 / $604.23 / $687.50	Professional		$604.23	$604.23	$687.50