Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $195.81 / $370.40 / $13,750.00	Facility		$195.81	$370.40	$13,750.00
Aetna Facility/Professional Facility Modifier 50 Low / Median / High Price $453.51 / $758.64 / $2,426.48	Facility	50	$453.51	$758.64	$2,426.48
Aetna Facility/Professional Professional Modifier Low / Median / High Price $134.85 / $175.22 / $351.45	Professional		$134.85	$175.22	$351.45
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $220.04 / $800.49 / $993.59	Professional	50	$220.04	$800.49	$993.59
Asuris Northwest Health Facility/Professional Facility Modifier Low / Median / High Price $176.29 / $788.95 / $1,605.58	Facility		$176.29	$788.95	$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 $186.19 / $287.87 / $1,528.92	Professional		$186.19	$287.87	$1,528.92
Asuris Northwest Health Facility/Professional Professional Modifier 50 Low / Median / High Price $282.52 / $406.13 / $583.50	Professional	50	$282.52	$406.13	$583.50
Cigna Facility/Professional Facility Modifier Low / Median / High Price $187.71 / $500.00 / $568.48	Facility		$187.71	$500.00	$568.48
Cigna Facility/Professional Professional Modifier Low / Median / High Price $139.65 / $238.32 / $399.90	Professional		$139.65	$238.32	$399.90
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $126.17 / $221.02 / $339.60	Facility		$126.17	$221.02	$339.60
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 $126.17 / $214.76 / $339.12	Professional		$126.17	$214.76	$339.12
Molina Facility/Professional Professional Modifier Low / Median / High Price $27.30 / $151.02 / $268.41	Professional		$27.30	$151.02	$268.41
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $180.72 / $255.94 / $278.72	Facility		$180.72	$255.94	$278.72
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $58.71 / $182.56 / $190.11	Facility		$58.71	$182.56	$190.11
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $190.11 / $274.43 / $343.27	Professional		$190.11	$274.43	$343.27
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 $175.88 / $253.90 / $339.47	Professional		$175.88	$253.90	$339.47
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 $164.26 / $227.36 / $388.55	Professional		$164.26	$227.36	$388.55
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $114.57 / $130.55 / $152.25	Professional		$114.57	$130.55	$152.25