Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $362.89 / $3,499.13 / $8,805.35	Facility		$362.89	$3,499.13	$8,805.35
Aetna Facility/Professional Facility Modifier 52 Low / Median / High Price $136.24 / $328.40 / $578.26	Facility	52	$136.24	$328.40	$578.26
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $54.49 / $116.68 / $215.83	Facility	53	$54.49	$116.68	$215.83
Aetna Facility/Professional Professional Modifier Low / Median / High Price $224.30 / $451.88 / $1,156.51	Professional		$224.30	$451.88	$1,156.51
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $104.20 / $217.24 / $525.88	Professional	52	$104.20	$217.24	$525.88
Aetna Facility/Professional Professional Modifier 53 Low / Median / High Price $41.48 / $86.03 / $196.07	Professional	53	$41.48	$86.03	$196.07
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $193.09 / $308.94 / $387.09	Professional		$193.09	$308.94	$387.09
Ambetter Facility/Professional Professional Modifier 52 Low / Median / High Price $87.13 / $87.13 / $87.13	Professional	52	$87.13	$87.13	$87.13
Ambetter Facility/Professional Professional Modifier 53 Low / Median / High Price $287.50 / $287.50 / $289.50	Professional	53	$287.50	$287.50	$289.50
Asuris Northwest Health Facility/Professional Facility Modifier Low / Median / High Price $602.49 / $3,143.37 / $16,394.00	Facility		$602.49	$3,143.37	$16,394.00
Asuris Northwest Health Facility/Professional Facility Modifier 52 Low / Median / High Price $405.92 / $721.81 / $721.81	Facility	52	$405.92	$721.81	$721.81
Asuris Northwest Health Facility/Professional Facility Modifier 53 Low / Median / High Price $101.48 / $180.45 / $180.45	Facility	53	$101.48	$180.45	$180.45
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $339.29 / $844.21 / $3,212.16	Professional		$339.29	$844.21	$3,212.16
Asuris Northwest Health Facility/Professional Professional Modifier 52 Low / Median / High Price $147.97 / $147.97 / $147.97	Professional	52	$147.97	$147.97	$147.97
Asuris Northwest Health Facility/Professional Professional Modifier 53 Low / Median / High Price $73.98 / $73.98 / $129.96	Professional	53	$73.98	$73.98	$129.96
Cigna Facility/Professional Facility Modifier Low / Median / High Price $625.25 / $761.81 / $1,499.24	Facility		$625.25	$761.81	$1,499.24
Cigna Facility/Professional Professional Modifier Low / Median / High Price $273.02 / $544.62 / $1,221.91	Professional		$273.02	$544.62	$1,221.91
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $311.93 / $625.96 / $1,228.59	Facility		$311.93	$625.96	$1,228.59
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $294.00 / $591.58 / $1,137.59	Professional		$294.00	$591.58	$1,137.59
Molina Facility/Professional Professional Modifier Low / Median / High Price $116.80 / $707.92 / $1,200.51	Professional		$116.80	$707.92	$1,200.51
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $487.63 / $804.34 / $886.41	Facility		$487.63	$804.34	$886.41
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $552.13 / $602.49 / $874.44	Facility		$552.13	$602.49	$874.44
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $326.13 / $593.64 / $1,128.22	Professional		$326.13	$593.64	$1,128.22
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $2,168.55 / $3,344.18 / $6,397.05	Facility		$2,168.55	$3,344.18	$6,397.05
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $339.29 / $607.69 / $1,004.97	Professional		$339.29	$607.69	$1,004.97
United Facility/Professional Facility Modifier Low / Median / High Price $650.00 / $1,120.00 / $6,857.00	Facility		$650.00	$1,120.00	$6,857.00
United Facility/Professional Professional Modifier Low / Median / High Price $462.67 / $703.54 / $1,238.80	Professional		$462.67	$703.54	$1,238.80
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $209.24 / $353.92 / $479.95	Professional		$209.24	$353.92	$479.95