Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $104.60 / $218.67 / $13,750.00	Facility		$104.60	$218.67	$13,750.00
Aetna Facility/Professional Facility Modifier 50 Low / Median / High Price $48.76 / $764.75 / $1,120.26	Facility	50	$48.76	$764.75	$1,120.26
Aetna Facility/Professional Professional Modifier Low / Median / High Price $55.28 / $95.19 / $299.00	Professional		$55.28	$95.19	$299.00
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $122.29 / $311.18 / $523.50	Professional	50	$122.29	$311.18	$523.50
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $35.54 / $100.51 / $180.01	Professional		$35.54	$100.51	$180.01
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $185.04 / $185.04 / $185.04	Professional	50	$185.04	$185.04	$185.04
Asuris Northwest Health Facility/Professional Facility Modifier Low / Median / High Price $99.45 / $786.75 / $1,605.58	Facility		$99.45	$786.75	$1,605.58
Asuris Northwest Health Facility/Professional Facility Modifier 50 Low / Median / High Price $905.78 / $1,259.03 / $2,435.71	Facility	50	$905.78	$1,259.03	$2,435.71
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $96.69 / $159.53 / $613.73	Professional		$96.69	$159.53	$613.73
Asuris Northwest Health Facility/Professional Professional Modifier 50 Low / Median / High Price $135.47 / $238.61 / $295.50	Professional	50	$135.47	$238.61	$295.50
Cigna Facility/Professional Facility Modifier Low / Median / High Price $107.27 / $500.00 / $568.48	Facility		$107.27	$500.00	$568.48
Cigna Facility/Professional Professional Modifier Low / Median / High Price $68.94 / $122.41 / $232.54	Professional		$68.94	$122.41	$232.54
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $66.59 / $115.08 / $191.11	Facility		$66.59	$115.08	$191.11
Kaiser Permanente Facility/Professional Facility Modifier 50 Low / Median / High Price $670.80 / $878.49 / $2,113.65	Facility	50	$670.80	$878.49	$2,113.65
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $66.59 / $115.08 / $186.86	Professional		$66.59	$115.08	$186.86
Molina Facility/Professional Professional Modifier Low / Median / High Price $18.21 / $101.08 / $178.26	Professional		$18.21	$101.08	$178.26
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $101.99 / $147.40 / $166.16	Facility		$101.99	$147.40	$166.16
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $33.11 / $110.53 / $113.34	Facility		$33.11	$110.53	$113.34
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $95.92 / $141.27 / $205.04	Professional		$95.92	$141.27	$205.04
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $544.28 / $838.87 / $1,605.58	Facility		$544.28	$838.87	$1,605.58
Regence BlueShield Facility/Professional Facility Modifier 50 Low / Median / High Price $816.42 / $1,258.31 / $2,408.37	Facility	50	$816.42	$1,258.31	$2,408.37
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $86.63 / $130.85 / $195.45	Professional		$86.63	$130.85	$195.45
United Facility/Professional Facility Modifier Low / Median / High Price $546.00 / $1,055.78 / $1,995.12	Facility		$546.00	$1,055.78	$1,995.12
United Facility/Professional Professional Modifier Low / Median / High Price $94.50 / $131.51 / $233.69	Professional		$94.50	$131.51	$233.69
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $60.20 / $69.02 / $91.38	Professional		$60.20	$69.02	$91.38