Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $2,650.33 / $19,396.00 / $78,790.28	Facility		$2,650.33	$19,396.00	$78,790.28
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,291.36 / $1,832.80 / $5,786.00	Professional		$1,291.36	$1,832.80	$5,786.00
Aetna Facility/Professional Professional Modifier AS Low / Median / High Price $104.54 / $683.55 / $3,870.51	Professional	AS	$104.54	$683.55	$3,870.51
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $1,380.37 / $2,089.64 / $2,863.58	Professional		$1,380.37	$2,089.64	$2,863.58
Asuris Northwest Health Facility/Professional Facility Modifier Low / Median / High Price $1,984.75 / $50,139.86 / $101,024.36	Facility		$1,984.75	$50,139.86	$101,024.36
Asuris Northwest Health Facility/Professional Facility Modifier AS Low / Median / High Price $4,693.22 / $7,806.31 / $7,806.31	Facility	AS	$4,693.22	$7,806.31	$7,806.31
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $2,056.71 / $3,402.08 / $12,620.25	Professional		$2,056.71	$3,402.08	$12,620.25
Asuris Northwest Health Facility/Professional Professional Modifier AS Low / Median / High Price $311.98 / $389.03 / $389.03	Professional	AS	$311.98	$389.03	$389.03
Cigna Facility/Professional Facility Modifier Low / Median / High Price $765.00 / $870.49 / $34,392.30	Facility		$765.00	$870.49	$34,392.30
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,530.78 / $2,584.14 / $4,367.14	Professional		$1,530.78	$2,584.14	$4,367.14
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $1,610.25 / $3,239.69 / $30,160.90	Facility		$1,610.25	$3,239.69	$30,160.90
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $1,487.29 / $3,075.68 / $25,809.35	Professional		$1,487.29	$3,075.68	$25,809.35
Molina Facility/Professional Professional Modifier Low / Median / High Price $157.37 / $875.53 / $2,781.29	Professional		$157.37	$875.53	$2,781.29
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $2,058.00 / $2,810.57 / $2,909.81	Facility		$2,058.00	$2,810.57	$2,909.81
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $1,940.20 / $1,984.75 / $20,825.14	Facility		$1,940.20	$1,984.75	$20,825.14
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $2,219.10 / $3,169.42 / $3,939.54	Professional		$2,219.10	$3,169.42	$3,939.54
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $32,006.94 / $51,535.83 / $101,024.36	Facility		$32,006.94	$51,535.83	$101,024.36
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $1,978.75 / $2,848.22 / $3,800.72	Professional		$1,978.75	$2,848.22	$3,800.72
United Facility/Professional Facility Modifier Low / Median / High Price $3,700.00 / $8,600.00 / $24,236.00	Facility		$3,700.00	$8,600.00	$24,236.00
United Facility/Professional Professional Modifier Low / Median / High Price $1,805.14 / $2,375.44 / $4,170.00	Professional		$1,805.14	$2,375.44	$4,170.00
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $1,207.52 / $1,207.52 / $1,547.88	Professional		$1,207.52	$1,207.52	$1,547.88