Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $61.33 / $136.25 / $13,750.00	Facility		$61.33	$136.25	$13,750.00
Aetna Facility/Professional Facility Modifier 50 Low / Median / High Price $588.12 / $588.12 / $588.12	Facility	50	$588.12	$588.12	$588.12
Aetna Facility/Professional Professional Modifier Low / Median / High Price $33.32 / $55.89 / $182.32	Professional		$33.32	$55.89	$182.32
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $60.55 / $64.88 / $194.45	Professional	50	$60.55	$64.88	$194.45
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $48.94 / $50.14 / $72.78	Professional		$48.94	$50.14	$72.78
Asuris Northwest Health Facility/Professional Facility Modifier Low / Median / High Price $55.00 / $786.75 / $1,605.58	Facility		$55.00	$786.75	$1,605.58
Asuris Northwest Health Facility/Professional Facility Modifier 50 Low / Median / High Price $905.78 / $1,259.03 / $2,435.71	Facility	50	$905.78	$1,259.03	$2,435.71
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $57.72 / $95.82 / $376.88	Professional		$57.72	$95.82	$376.88
Asuris Northwest Health Facility/Professional Professional Modifier 50 Low / Median / High Price $81.72 / $101.90 / $173.53	Professional	50	$81.72	$101.90	$173.53
Cigna Facility/Professional Facility Modifier Low / Median / High Price $52.87 / $714.97 / $870.49	Facility		$52.87	$714.97	$870.49
Cigna Facility/Professional Professional Modifier Low / Median / High Price $42.15 / $74.50 / $139.37	Professional		$42.15	$74.50	$139.37
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $39.20 / $71.25 / $119.74	Facility		$39.20	$71.25	$119.74
Kaiser Permanente Facility/Professional Facility Modifier 50 Low / Median / High Price $670.80 / $878.49 / $2,113.65	Facility	50	$670.80	$878.49	$2,113.65
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $39.20 / $69.75 / $116.12	Professional		$39.20	$69.75	$116.12
Molina Facility/Professional Professional Modifier Low / Median / High Price $18.01 / $101.08 / $178.26	Professional		$18.01	$101.08	$178.26
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $64.80 / $91.12 / $100.50	Facility		$64.80	$91.12	$100.50
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $16.30 / $66.59 / $68.55	Facility		$16.30	$66.59	$68.55
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $56.19 / $82.52 / $123.36	Professional		$56.19	$82.52	$123.36
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $544.28 / $838.87 / $1,605.58	Facility		$544.28	$838.87	$1,605.58
Regence BlueShield Facility/Professional Facility Modifier 50 Low / Median / High Price $816.42 / $1,258.31 / $2,408.37	Facility	50	$816.42	$1,258.31	$2,408.37
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $52.50 / $78.42 / $117.41	Professional		$52.50	$78.42	$117.41
United Facility/Professional Facility Modifier Low / Median / High Price $157.00 / $546.00 / $5,793.00	Facility		$157.00	$546.00	$5,793.00
United Facility/Professional Professional Modifier Low / Median / High Price $59.64 / $80.03 / $136.61	Professional		$59.64	$80.03	$136.61
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $34.18 / $41.14 / $53.91	Professional		$34.18	$41.14	$53.91