Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $107.00 / $317.22 / $13,750.00	Facility		$107.00	$317.22	$13,750.00
Aetna Facility/Professional Facility Modifier 50 Low / Median / High Price $2,612.60 / $2,612.60 / $2,612.60	Facility	50	$2,612.60	$2,612.60	$2,612.60
Aetna Facility/Professional Professional Modifier Low / Median / High Price $61.15 / $131.02 / $275.11	Professional		$61.15	$131.02	$275.11
Asuris Northwest Health Facility/Professional Facility Modifier Low / Median / High Price $266.43 / $1,959.77 / $5,070.50	Facility		$266.43	$1,959.77	$5,070.50
Asuris Northwest Health Facility/Professional Facility Modifier 50 Low / Median / High Price $2,285.07 / $3,052.92 / $5,687.07	Facility	50	$2,285.07	$3,052.92	$5,687.07
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $99.90 / $178.97 / $1,340.00	Professional		$99.90	$178.97	$1,340.00
Asuris Northwest Health Facility/Professional Professional Modifier 50 Low / Median / High Price $142.07 / $177.15 / $293.61	Professional	50	$142.07	$177.15	$293.61
Cigna Facility/Professional Facility Modifier Low / Median / High Price $466.83 / $568.48 / $880.53	Facility		$466.83	$568.48	$880.53
Cigna Facility/Professional Professional Modifier Low / Median / High Price $81.56 / $153.47 / $284.47	Professional		$81.56	$153.47	$284.47
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $84.05 / $161.54 / $648.52	Facility		$84.05	$161.54	$648.52
Kaiser Permanente Facility/Professional Facility Modifier 50 Low / Median / High Price $976.01 / $1,928.84 / $4,640.79	Facility	50	$976.01	$1,928.84	$4,640.79
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $84.05 / $159.69 / $393.92	Professional		$84.05	$159.69	$393.92
Molina Facility/Professional Professional Modifier Low / Median / High Price $27.13 / $151.29 / $268.52	Professional		$27.13	$151.29	$268.52
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $129.97 / $193.14 / $226.58	Facility		$129.97	$193.14	$226.58
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $131.37 / $134.36 / $715.32	Facility		$131.37	$134.36	$715.32
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $98.19 / $150.53 / $242.55	Professional		$98.19	$150.53	$242.55
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $1,270.82 / $1,958.65 / $3,748.81	Facility		$1,270.82	$1,958.65	$3,748.81
Regence BlueShield Facility/Professional Facility Modifier 50 Low / Median / High Price $2,245.42 / $2,995.70 / $5,623.22	Facility	50	$2,245.42	$2,995.70	$5,623.22
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $93.16 / $143.04 / $241.53	Professional		$93.16	$143.04	$241.53
United Facility/Professional Facility Modifier Low / Median / High Price $472.00 / $938.00 / $4,611.00	Facility		$472.00	$938.00	$4,611.00
United Facility/Professional Professional Modifier Low / Median / High Price $122.56 / $203.00 / $281.66	Professional		$122.56	$203.00	$281.66
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $61.85 / $81.44 / $108.81	Professional		$61.85	$81.44	$108.81