Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $483.12 / $4,162.50 / $16,398.00	Facility		$483.12	$4,162.50	$16,398.00
Aetna Facility/Professional Facility Modifier 50 Low / Median / High Price $5,820.64 / $5,820.64 / $7,071.30	Facility	50	$5,820.64	$5,820.64	$7,071.30
Aetna Facility/Professional Professional Modifier Low / Median / High Price $339.91 / $592.61 / $1,162.04	Professional		$339.91	$592.61	$1,162.04
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $242.88 / $242.88 / $242.88	Professional	50	$242.88	$242.88	$242.88
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $169.96 / $296.31 / $638.89	Professional	52	$169.96	$296.31	$638.89
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $136.97 / $470.73 / $822.90	Professional		$136.97	$470.73	$822.90
Asuris Northwest Health Facility/Professional Facility Modifier Low / Median / High Price $573.54 / $8,490.57 / $17,279.07	Facility		$573.54	$8,490.57	$17,279.07
Asuris Northwest Health Facility/Professional Facility Modifier 50 Low / Median / High Price $9,667.96 / $13,549.47 / $26,212.89	Facility	50	$9,667.96	$13,549.47	$26,212.89
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $483.83 / $805.21 / $3,589.98	Professional		$483.83	$805.21	$3,589.98
Asuris Northwest Health Facility/Professional Professional Modifier 50 Low / Median / High Price $635.92 / $1,105.50 / $1,449.00	Professional	50	$635.92	$1,105.50	$1,449.00
Cigna Facility/Professional Facility Modifier Low / Median / High Price $491.87 / $491.87 / $491.87	Facility		$491.87	$491.87	$491.87
Cigna Facility/Professional Professional Modifier Low / Median / High Price $528.27 / $783.67 / $1,256.20	Professional		$528.27	$783.67	$1,256.20
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $431.36 / $986.47 / $2,923.63	Facility		$431.36	$986.47	$2,923.63
Kaiser Permanente Facility/Professional Facility Modifier 50 Low / Median / High Price $6,901.60 / $11,895.06 / $21,599.49	Facility	50	$6,901.60	$11,895.06	$21,599.49
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $547.04 / $953.86 / $1,420.39	Professional		$547.04	$953.86	$1,420.39
Molina Facility/Professional Professional Modifier Low / Median / High Price $48.15 / $468.42 / $903.71	Professional		$48.15	$468.42	$903.71
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $674.66 / $840.85 / $1,251.56	Facility		$674.66	$840.85	$1,251.56
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $573.54 / $573.54 / $583.91	Facility		$573.54	$573.54	$583.91
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $476.33 / $688.70 / $1,051.31	Professional		$476.33	$688.70	$1,051.31
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $5,857.48 / $9,027.82 / $17,279.07	Facility		$5,857.48	$9,027.82	$17,279.07
Regence BlueShield Facility/Professional Facility Modifier 50 Low / Median / High Price $8,786.21 / $13,541.73 / $25,918.61	Facility	50	$8,786.21	$13,541.73	$25,918.61
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $452.09 / $660.68 / $974.51	Professional		$452.09	$660.68	$974.51
United Facility/Professional Facility Modifier Low / Median / High Price $2,155.00 / $6,295.00 / $11,941.00	Facility		$2,155.00	$6,295.00	$11,941.00
United Facility/Professional Professional Modifier Low / Median / High Price $556.26 / $849.57 / $1,236.31	Professional		$556.26	$849.57	$1,236.31