Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $290.91 / $2,742.16 / $4,908.08	Facility		$290.91	$2,742.16	$4,908.08
Aetna Facility/Professional Facility Modifier 50 Low / Median / High Price $2,265.48 / $3,927.74 / $5,603.40	Facility	50	$2,265.48	$3,927.74	$5,603.40
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $40.52 / $66.67 / $124.81	Facility	53	$40.52	$66.67	$124.81
Aetna Facility/Professional Professional Modifier Low / Median / High Price $99.29 / $273.50 / $1,071.00	Professional		$99.29	$273.50	$1,071.00
Aetna Facility/Professional Professional Modifier 22 Low / Median / High Price $141.52 / $141.52 / $191.19	Professional	22	$141.52	$141.52	$191.19
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $148.93 / $442.75 / $1,530.00	Professional	50	$148.93	$442.75	$1,530.00
Aetna Facility/Professional Professional Modifier 53 Low / Median / High Price $21.71 / $54.70 / $121.43	Professional	53	$21.71	$54.70	$121.43
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $105.85 / $146.84 / $290.83	Professional		$105.85	$146.84	$290.83
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $301.83 / $495.54 / $516.19	Professional	50	$301.83	$495.54	$516.19
Asuris Northwest Health Facility/Professional Facility Modifier Low / Median / High Price $419.07 / $2,583.03 / $6,683.07	Facility		$419.07	$2,583.03	$6,683.07
Asuris Northwest Health Facility/Professional Facility Modifier 50 Low / Median / High Price $2,424.63 / $3,874.55 / $7,495.73	Facility	50	$2,424.63	$3,874.55	$7,495.73
Asuris Northwest Health Facility/Professional Facility Modifier 53 Low / Median / High Price $57.80 / $100.82 / $100.82	Facility	53	$57.80	$100.82	$100.82
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $186.92 / $426.60 / $4,050.50	Professional		$186.92	$426.60	$4,050.50
Asuris Northwest Health Facility/Professional Professional Modifier 50 Low / Median / High Price $270.26 / $336.99 / $745.50	Professional	50	$270.26	$336.99	$745.50
Cigna Facility/Professional Facility Modifier Low / Median / High Price $466.83 / $568.48 / $1,132.06	Facility		$466.83	$568.48	$1,132.06
Cigna Facility/Professional Professional Modifier Low / Median / High Price $139.62 / $291.29 / $698.01	Professional		$139.62	$291.29	$698.01
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $144.90 / $288.38 / $840.73	Facility		$144.90	$288.38	$840.73
Kaiser Permanente Facility/Professional Facility Modifier 50 Low / Median / High Price $1,907.75 / $2,550.75 / $5,846.21	Facility	50	$1,907.75	$2,550.75	$5,846.21
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $144.90 / $283.52 / $715.68	Professional		$144.90	$283.52	$715.68
Molina Facility/Professional Professional Modifier Low / Median / High Price $63.41 / $352.49 / $624.85	Professional		$63.41	$352.49	$624.85
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $237.60 / $424.08 / $495.80	Facility		$237.60	$424.08	$495.80
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $308.82 / $337.03 / $927.31	Facility		$308.82	$337.03	$927.31
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $185.04 / $323.75 / $613.46	Professional		$185.04	$323.75	$613.46
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $1,674.98 / $2,581.55 / $4,941.05	Facility		$1,674.98	$2,581.55	$4,941.05
Regence BlueShield Facility/Professional Facility Modifier 50 Low / Median / High Price $2,512.46 / $3,872.33 / $7,411.58	Facility	50	$2,512.46	$3,872.33	$7,411.58
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $176.09 / $343.73 / $586.91	Professional		$176.09	$343.73	$586.91
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 $287.95 / $403.69 / $699.20	Professional		$287.95	$403.69	$699.20
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $118.63 / $201.53 / $275.30	Professional		$118.63	$201.53	$275.30