Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $1,202.57 / $15,773.03 / $30,542.85	Facility		$1,202.57	$15,773.03	$30,542.85
Aetna Facility/Professional Facility Modifier 52 Low / Median / High Price $449.66 / $604.57 / $926.63	Facility	52	$449.66	$604.57	$926.63
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $179.86 / $241.83 / $370.65	Facility	53	$179.86	$241.83	$370.65
Aetna Facility/Professional Professional Modifier Low / Median / High Price $632.69 / $946.88 / $2,956.00	Professional		$632.69	$946.88	$2,956.00
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $1,029.70 / $1,287.11 / $1,713.11	Professional		$1,029.70	$1,287.11	$1,713.11
Asuris Northwest Health Facility/Professional Facility Modifier Low / Median / High Price $2,429.53 / $14,160.61 / $21,602.23	Facility		$2,429.53	$14,160.61	$21,602.23
Asuris Northwest Health Facility/Professional Facility Modifier 52 Low / Median / High Price $7,396.23 / $12,302.24 / $12,302.24	Facility	52	$7,396.23	$12,302.24	$12,302.24
Asuris Northwest Health Facility/Professional Facility Modifier 53 Low / Median / High Price $1,849.06 / $3,075.56 / $3,075.56	Facility	53	$1,849.06	$3,075.56	$3,075.56
Asuris Northwest Health Facility/Professional Facility Modifier AS Low / Median / High Price $924.53 / $1,537.78 / $1,537.78	Facility	AS	$924.53	$1,537.78	$1,537.78
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $959.50 / $1,567.56 / $5,857.65	Professional		$959.50	$1,567.56	$5,857.65
Cigna Facility/Professional Facility Modifier Low / Median / High Price $2,000.00 / $2,285.42 / $6,775.01	Facility		$2,000.00	$2,285.42	$6,775.01
Cigna Facility/Professional Professional Modifier Low / Median / High Price $671.12 / $1,175.68 / $1,986.96	Professional		$671.12	$1,175.68	$1,986.96
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $758.69 / $1,469.76 / $6,197.13	Facility		$758.69	$1,469.76	$6,197.13
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $630.16 / $1,396.38 / $4,564.68	Professional		$630.16	$1,396.38	$4,564.68
Molina Facility/Professional Professional Modifier Low / Median / High Price $98.49 / $747.39 / $1,506.05	Professional		$98.49	$747.39	$1,506.05
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $1,011.91 / $1,274.81 / $1,334.64	Facility		$1,011.91	$1,274.81	$1,334.64
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $895.13 / $2,010.99 / $3,875.03	Facility		$895.13	$2,010.99	$3,875.03
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $948.48 / $1,503.54 / $1,814.76	Professional		$948.48	$1,503.54	$1,814.76
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $10,603.20 / $16,351.48 / $31,278.54	Facility		$10,603.20	$16,351.48	$31,278.54
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $1,057.16 / $1,309.54 / $1,721.28	Professional		$1,057.16	$1,309.54	$1,721.28
United Facility/Professional Facility Modifier Low / Median / High Price $1,900.00 / $4,686.00 / $19,271.00	Facility		$1,900.00	$4,686.00	$19,271.00
United Facility/Professional Professional Modifier Low / Median / High Price $709.51 / $1,113.02 / $1,907.83	Professional		$709.51	$1,113.02	$1,907.83
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $553.79 / $700.58 / $700.58	Professional		$553.79	$700.58	$700.58