Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $3,208.53 / $31,537.80 / $61,128.26	Facility		$3,208.53	$31,537.80	$61,128.26
Aetna Facility/Professional Facility Modifier 50 Low / Median / High Price $800.15 / $51,285.21 / $51,285.21	Facility	50	$800.15	$51,285.21	$51,285.21
Aetna Facility/Professional Facility Modifier 54 Low / Median / High Price $1,219.63 / $1,976.32 / $2,882.55	Facility	54	$1,219.63	$1,976.32	$2,882.55
Aetna Facility/Professional Facility Modifier AS Low / Median / High Price $13,896.56 / $13,896.56 / $13,896.56	Facility	AS	$13,896.56	$13,896.56	$13,896.56
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,171.91 / $1,802.87 / $23,392.00	Professional		$1,171.91	$1,802.87	$23,392.00
Aetna Facility/Professional Professional Modifier AS Low / Median / High Price $68.37 / $433.81 / $920.83	Professional	AS	$68.37	$433.81	$920.83
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $316.54 / $2,277.17 / $2,753.40	Professional		$316.54	$2,277.17	$2,753.40
Asuris Northwest Health Facility/Professional Facility Modifier Low / Median / High Price $6,543.05 / $34,902.00 / $71,345.31	Facility		$6,543.05	$34,902.00	$71,345.31
Asuris Northwest Health Facility/Professional Facility Modifier 50 Low / Median / High Price $42,733.83 / $52,586.36 / $108,233.07	Facility	50	$42,733.83	$52,586.36	$108,233.07
Asuris Northwest Health Facility/Professional Facility Modifier 54 Low / Median / High Price $21,379.17 / $35,560.28 / $35,560.28	Facility	54	$21,379.17	$35,560.28	$35,560.28
Asuris Northwest Health Facility/Professional Facility Modifier 62 Low / Median / High Price $19,088.54 / $31,750.25 / $31,750.25	Facility	62	$19,088.54	$31,750.25	$31,750.25
Asuris Northwest Health Facility/Professional Facility Modifier AS Low / Median / High Price $3,054.17 / $5,080.04 / $5,080.04	Facility	AS	$3,054.17	$5,080.04	$5,080.04
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $1,817.16 / $2,806.31 / $13,550.61	Professional		$1,817.16	$2,806.31	$13,550.61
Asuris Northwest Health Facility/Professional Professional Modifier AS Low / Median / High Price $277.16 / $345.60 / $359.71	Professional	AS	$277.16	$345.60	$359.71
Cigna Facility/Professional Facility Modifier Low / Median / High Price $714.97 / $765.00 / $870.49	Facility		$714.97	$765.00	$870.49
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,423.53 / $2,396.90 / $3,881.56	Professional		$1,423.53	$2,396.90	$3,881.56
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $1,588.50 / $3,064.13 / $20,472.14	Facility		$1,588.50	$3,064.13	$20,472.14
Kaiser Permanente Facility/Professional Facility Modifier 50 Low / Median / High Price $20,694.25 / $45,258.40 / $108,891.50	Facility	50	$20,694.25	$45,258.40	$108,891.50
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $1,427.26 / $2,915.37 / $17,234.20	Professional		$1,427.26	$2,915.37	$17,234.20
Molina Facility/Professional Professional Modifier Low / Median / High Price $156.75 / $740.04 / $2,510.55	Professional		$156.75	$740.04	$2,510.55
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $1,932.98 / $2,498.48 / $2,627.07	Facility		$1,932.98	$2,498.48	$2,627.07
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $1,722.31 / $1,765.39 / $19,647.18	Facility		$1,722.31	$1,765.39	$19,647.18
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $1,972.48 / $2,813.48 / $3,504.13	Professional		$1,972.48	$2,813.48	$3,504.13
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $28,458.00 / $36,469.56 / $71,345.31	Facility		$28,458.00	$36,469.56	$71,345.31
Regence BlueShield Facility/Professional Facility Modifier 50 Low / Median / High Price $42,687.00 / $54,704.34 / $107,017.97	Facility	50	$42,687.00	$54,704.34	$107,017.97
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $1,756.52 / $2,529.82 / $3,419.50	Professional		$1,756.52	$2,529.82	$3,419.50
United Facility/Professional Facility Modifier Low / Median / High Price $3,700.00 / $13,441.00 / $25,050.00	Facility		$3,700.00	$13,441.00	$25,050.00
United Facility/Professional Professional Modifier Low / Median / High Price $1,646.82 / $2,215.02 / $3,733.90	Professional		$1,646.82	$2,215.02	$3,733.90
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $1,074.73 / $1,074.73 / $1,376.70	Professional		$1,074.73	$1,074.73	$1,376.70