Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $710.00 / $2,909.39 / $9,168.10	Facility		$710.00	$2,909.39	$9,168.10
Aetna Facility/Professional Facility Modifier 54 Low / Median / High Price $532.50 / $840.00 / $1,085.44	Facility	54	$532.50	$840.00	$1,085.44
Aetna Facility/Professional Professional Modifier Low / Median / High Price $529.45 / $725.63 / $1,638.00	Professional		$529.45	$725.63	$1,638.00
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $744.90 / $785.78 / $1,290.91	Professional		$744.90	$785.78	$1,290.91
Asuris Northwest Health Facility/Professional Facility Modifier Low / Median / High Price $1,613.81 / $4,554.63 / $11,500.00	Facility		$1,613.81	$4,554.63	$11,500.00
Asuris Northwest Health Facility/Professional Facility Modifier 54 Low / Median / High Price $939.82 / $1,688.06 / $1,688.06	Facility	54	$939.82	$1,688.06	$1,688.06
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $764.90 / $1,231.18 / $4,604.18	Professional		$764.90	$1,231.18	$4,604.18
Cigna Facility/Professional Facility Modifier Low / Median / High Price $714.97 / $870.49 / $1,985.59	Facility		$714.97	$870.49	$1,985.59
Cigna Facility/Professional Professional Modifier Low / Median / High Price $554.41 / $999.45 / $1,683.30	Professional		$554.41	$999.45	$1,683.30
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $545.16 / $1,082.52 / $1,509.14	Facility		$545.16	$1,082.52	$1,509.14
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $526.61 / $1,054.86 / $1,499.41	Professional		$526.61	$1,054.86	$1,499.41
Molina Facility/Professional Professional Modifier Low / Median / High Price $76.76 / $304.39 / $1,057.56	Professional		$76.76	$304.39	$1,057.56
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $750.01 / $1,037.16 / $1,123.58	Facility		$750.01	$1,037.16	$1,123.58
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $537.44 / $735.22 / $1,613.81	Facility		$537.44	$735.22	$1,613.81
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $766.39 / $1,189.29 / $1,435.03	Professional		$766.39	$1,189.29	$1,435.03
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $2,953.48 / $4,552.03 / $8,712.50	Facility		$2,953.48	$4,552.03	$8,712.50
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $749.83 / $1,040.99 / $1,403.90	Professional		$749.83	$1,040.99	$1,403.90
United Facility/Professional Facility Modifier Low / Median / High Price $472.00 / $938.00 / $4,611.00	Facility		$472.00	$938.00	$4,611.00
United Facility/Professional Professional Modifier Low / Median / High Price $669.88 / $900.75 / $1,572.24	Professional		$669.88	$900.75	$1,572.24
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $466.28 / $577.78 / $615.66	Professional		$466.28	$577.78	$615.66