Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $2,198.02 / $20,140.00 / $60,027.55	Facility		$2,198.02	$20,140.00	$60,027.55
Aetna Facility/Professional Facility Modifier 22 Low / Median / High Price $26,560.80 / $26,560.80 / $26,560.80	Facility	22	$26,560.80	$26,560.80	$26,560.80
Aetna Facility/Professional Facility Modifier 50 Low / Median / High Price $31,338.00 / $31,338.00 / $61,179.02	Facility	50	$31,338.00	$31,338.00	$61,179.02
Aetna Facility/Professional Facility Modifier 54 Low / Median / High Price $1,218.08 / $1,975.43 / $2,881.27	Facility	54	$1,218.08	$1,975.43	$2,881.27
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,252.93 / $1,861.37 / $21,960.00	Professional		$1,252.93	$1,861.37	$21,960.00
Aetna Facility/Professional Professional Modifier AS Low / Median / High Price $170.88 / $637.63 / $974.39	Professional	AS	$170.88	$637.63	$974.39
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $1,193.68 / $2,053.35 / $2,612.21	Professional		$1,193.68	$2,053.35	$2,612.21
Asuris Northwest Health Facility/Professional Facility Modifier Low / Median / High Price $6,499.32 / $34,902.00 / $71,345.31	Facility		$6,499.32	$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 $20,941.49 / $34,832.28 / $34,832.28	Facility	54	$20,941.49	$34,832.28	$34,832.28
Asuris Northwest Health Facility/Professional Facility Modifier AS Low / Median / High Price $2,991.64 / $4,976.04 / $4,976.04	Facility	AS	$2,991.64	$4,976.04	$4,976.04
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $1,814.33 / $2,825.25 / $11,316.67	Professional		$1,814.33	$2,825.25	$11,316.67
Asuris Northwest Health Facility/Professional Professional Modifier AS Low / Median / High Price $276.83 / $345.20 / $402.25	Professional	AS	$276.83	$345.20	$402.25
Cigna Facility/Professional Facility Modifier Low / Median / High Price $765.00 / $870.49 / $870.49	Facility		$765.00	$870.49	$870.49
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,422.89 / $2,404.17 / $3,875.76	Professional		$1,422.89	$2,404.17	$3,875.76
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $1,650.49 / $3,142.66 / $20,053.03	Facility		$1,650.49	$3,142.66	$20,053.03
Kaiser Permanente Facility/Professional Facility Modifier 50 Low / Median / High Price $20,694.25 / $38,497.46 / $92,624.72	Facility	50	$20,694.25	$38,497.46	$92,624.72
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $1,528.56 / $2,976.25 / $17,100.00	Professional		$1,528.56	$2,976.25	$17,100.00
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 $1,946.00 / $2,495.41 / $2,684.14	Facility		$1,946.00	$2,495.41	$2,684.14
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $1,720.49 / $1,762.65 / $19,515.89	Facility		$1,720.49	$1,762.65	$19,515.89
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $1,970.42 / $2,810.52 / $3,498.68	Professional		$1,970.42	$2,810.52	$3,498.68
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $28,458.00 / $35,057.57 / $71,345.31	Facility		$28,458.00	$35,057.57	$71,345.31
Regence BlueShield Facility/Professional Facility Modifier 50 Low / Median / High Price $42,687.00 / $52,586.36 / $107,017.97	Facility	50	$42,687.00	$52,586.36	$107,017.97
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $1,754.68 / $2,526.48 / $3,415.14	Professional		$1,754.68	$2,526.48	$3,415.14
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 $1,644.72 / $2,288.90 / $3,759.37	Professional		$1,644.72	$2,288.90	$3,759.37
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $1,073.34 / $1,073.34 / $1,374.85	Professional		$1,073.34	$1,073.34	$1,374.85