Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $82.87 / $809.51 / $3,170.00	Facility		$82.87	$809.51	$3,170.00
Aetna Facility/Professional Facility Modifier 50 Low / Median / High Price $370.24 / $707.19 / $3,170.00	Facility	50	$370.24	$707.19	$3,170.00
Aetna Facility/Professional Facility Modifier 52 Low / Median / High Price $41.14 / $59.16 / $78.42	Facility	52	$41.14	$59.16	$78.42
Aetna Facility/Professional Professional Modifier Low / Median / High Price $45.23 / $82.88 / $273.00	Professional		$45.23	$82.88	$273.00
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $89.96 / $155.34 / $422.67	Professional	50	$89.96	$155.34	$422.67
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $59.25 / $89.74 / $131.87	Professional		$59.25	$89.74	$131.87
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $83.62 / $132.09 / $197.80	Professional	50	$83.62	$132.09	$197.80
Asuris Northwest Health Facility/Professional Facility Modifier Low / Median / High Price $89.57 / $839.35 / $1,931.70	Facility		$89.57	$839.35	$1,931.70
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 Facility Modifier 52 Low / Median / High Price $91.53 / $164.70 / $164.70	Facility	52	$91.53	$164.70	$164.70
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $76.59 / $126.53 / $482.48	Professional		$76.59	$126.53	$482.48
Asuris Northwest Health Facility/Professional Professional Modifier 50 Low / Median / High Price $113.61 / $134.66 / $243.91	Professional	50	$113.61	$134.66	$243.91
Cigna Facility/Professional Facility Modifier Low / Median / High Price $79.68 / $500.00 / $568.48	Facility		$79.68	$500.00	$568.48
Cigna Facility/Professional Professional Modifier Low / Median / High Price $56.46 / $100.01 / $183.33	Professional		$56.46	$100.01	$183.33
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $52.64 / $92.79 / $162.97	Facility		$52.64	$92.79	$162.97
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 $51.92 / $92.23 / $151.01	Professional		$51.92	$92.23	$151.01
Molina Facility/Professional Professional Modifier Low / Median / High Price $18.18 / $101.08 / $178.26	Professional		$18.18	$101.08	$178.26
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $80.67 / $118.59 / $131.32	Facility		$80.67	$118.59	$131.32
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $25.34 / $86.98 / $89.57	Facility		$25.34	$86.98	$89.57
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $74.42 / $111.69 / $160.87	Professional		$74.42	$111.69	$160.87
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 $69.30 / $103.72 / $154.36	Professional		$69.30	$103.72	$154.36
United Facility/Professional Facility Modifier Low / Median / High Price $157.00 / $546.00 / $5,793.00	Facility		$157.00	$546.00	$5,793.00
United Facility/Professional Professional Modifier Low / Median / High Price $74.76 / $103.96 / $186.34	Professional		$74.76	$103.96	$186.34
United Facility/Professional Professional Modifier 50 Low / Median / High Price $80.00 / $85.00 / $136.40	Professional	50	$80.00	$85.00	$136.40
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $47.60 / $54.11 / $71.28	Professional		$47.60	$54.11	$71.28