Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $1,206.24 / $9,963.42 / $18,800.00	Facility		$1,206.24	$9,963.42	$18,800.00
Aetna Facility/Professional Facility Modifier 22 Low / Median / High Price $670.34 / $670.34 / $11,101.00	Facility	22	$670.34	$670.34	$11,101.00
Aetna Facility/Professional Facility Modifier 50 Low / Median / High Price $4,815.00 / $12,900.00 / $25,596.00	Facility	50	$4,815.00	$12,900.00	$25,596.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $525.09 / $836.19 / $1,897.20	Professional		$525.09	$836.19	$1,897.20
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $585.21 / $807.13 / $1,298.44	Professional		$585.21	$807.13	$1,298.44
Asuris Northwest Health Facility/Professional Facility Modifier Low / Median / High Price $6,126.02 / $10,802.03 / $26,542.00	Facility		$6,126.02	$10,802.03	$26,542.00
Asuris Northwest Health Facility/Professional Facility Modifier 50 Low / Median / High Price $10,306.59 / $16,203.05 / $31,346.52	Facility	50	$10,306.59	$16,203.05	$31,346.52
Asuris Northwest Health Facility/Professional Facility Modifier AS Low / Median / High Price $497.14 / $826.90 / $826.90	Facility	AS	$497.14	$826.90	$826.90
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $920.63 / $1,569.94 / $5,859.38	Professional		$920.63	$1,569.94	$5,859.38
Cigna Facility/Professional Facility Modifier Low / Median / High Price $2,186.71 / $2,186.71 / $3,643.05	Facility		$2,186.71	$2,186.71	$3,643.05
Cigna Facility/Professional Professional Modifier Low / Median / High Price $802.54 / $1,357.32 / $1,991.05	Professional		$802.54	$1,357.32	$1,991.05
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $809.87 / $1,377.14 / $6,433.53	Facility		$809.87	$1,377.14	$6,433.53
Kaiser Permanente Facility/Professional Facility Modifier 50 Low / Median / High Price $6,433.53 / $9,505.52 / $22,870.24	Facility	50	$6,433.53	$9,505.52	$22,870.24
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $816.90 / $1,310.50 / $2,454.52	Professional		$816.90	$1,310.50	$2,454.52
Molina Facility/Professional Professional Modifier Low / Median / High Price $74.23 / $266.72 / $1,354.61	Professional		$74.23	$266.72	$1,354.61
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $912.54 / $1,257.58 / $1,335.31	Facility		$912.54	$1,257.58	$1,335.31
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $894.22 / $910.80 / $1,239.50	Facility		$894.22	$910.80	$1,239.50
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $937.51 / $1,519.26 / $1,868.04	Professional		$937.51	$1,519.26	$1,868.04
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $7,004.63 / $10,795.86 / $20,663.07	Facility		$7,004.63	$10,795.86	$20,663.07
Regence BlueShield Facility/Professional Facility Modifier 50 Low / Median / High Price $10,506.95 / $16,193.79 / $30,994.61	Facility	50	$10,506.95	$16,193.79	$30,994.61
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $911.99 / $1,310.20 / $1,764.80	Professional		$911.99	$1,310.20	$1,764.80
United Facility/Professional Facility Modifier Low / Median / High Price $1,550.00 / $2,431.00 / $11,261.00	Facility		$1,550.00	$2,431.00	$11,261.00
United Facility/Professional Professional Modifier Low / Median / High Price $819.58 / $1,395.40 / $1,910.73	Professional		$819.58	$1,395.40	$1,910.73