Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $647.62 / $4,500.00 / $18,800.00	Facility		$647.62	$4,500.00	$18,800.00
Aetna Facility/Professional Facility Modifier 50 Low / Median / High Price $3,751.07 / $9,114.50 / $29,280.96	Facility	50	$3,751.07	$9,114.50	$29,280.96
Aetna Facility/Professional Professional Modifier Low / Median / High Price $312.62 / $1,054.82 / $3,590.78	Professional		$312.62	$1,054.82	$3,590.78
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $156.31 / $234.47 / $1,806.89	Professional	50	$156.31	$234.47	$1,806.89
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $573.30 / $573.30 / $3,229.30	Professional		$573.30	$573.30	$3,229.30
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $519.16 / $859.96 / $859.96	Professional	50	$519.16	$859.96	$859.96
Asuris Northwest Health Facility/Professional Facility Modifier Low / Median / High Price $3,661.25 / $12,328.50 / $20,574.02	Facility		$3,661.25	$12,328.50	$20,574.02
Asuris Northwest Health Facility/Professional Facility Modifier 50 Low / Median / High Price $16,018.07 / $23,359.80 / $45,192.02	Facility	50	$16,018.07	$23,359.80	$45,192.02
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $605.50 / $3,308.80 / $14,571.52	Professional		$605.50	$3,308.80	$14,571.52
Asuris Northwest Health Facility/Professional Professional Modifier 50 Low / Median / High Price $859.34 / $3,031.14 / $5,547.86	Professional	50	$859.34	$3,031.14	$5,547.86
Cigna Facility/Professional Professional Modifier Low / Median / High Price $452.49 / $1,158.08 / $5,338.50	Professional		$452.49	$1,158.08	$5,338.50
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $508.00 / $2,259.50 / $5,318.88	Facility		$508.00	$2,259.50	$5,318.88
Kaiser Permanente Facility/Professional Facility Modifier 50 Low / Median / High Price $13,984.77 / $19,774.45 / $35,907.16	Facility	50	$13,984.77	$19,774.45	$35,907.16
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $483.36 / $1,605.49 / $4,927.76	Professional		$483.36	$1,605.49	$4,927.76
Molina Facility/Professional Professional Modifier Low / Median / High Price $530.84 / $3,165.82 / $5,336.40	Professional		$530.84	$3,165.82	$5,336.40
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $2,127.56 / $3,559.39 / $4,000.57	Facility		$2,127.56	$3,559.39	$4,000.57
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $2,688.10 / $2,688.10 / $2,728.75	Facility		$2,688.10	$2,688.10	$2,728.75
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $648.23 / $2,688.10 / $5,294.25	Professional		$648.23	$2,688.10	$5,294.25
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $10,566.28 / $15,564.30 / $29,789.77	Facility		$10,566.28	$15,564.30	$29,789.77
Regence BlueShield Facility/Professional Facility Modifier 50 Low / Median / High Price $15,849.42 / $23,346.45 / $44,684.66	Facility	50	$15,849.42	$23,346.45	$44,684.66
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $642.50 / $1,353.48 / $4,621.55	Professional		$642.50	$1,353.48	$4,621.55
United Facility/Professional Facility Modifier Low / Median / High Price $3,028.00 / $5,851.00 / $20,708.00	Facility		$3,028.00	$5,851.00	$20,708.00
United Facility/Professional Professional Modifier Low / Median / High Price $2,132.00 / $3,342.60 / $5,753.42	Professional		$2,132.00	$3,342.60	$5,753.42
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $374.17 / $374.17 / $2,262.46	Professional		$374.17	$374.17	$2,262.46