Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $794.39 / $5,378.97 / $12,751.30	Facility		$794.39	$5,378.97	$12,751.30
Aetna Facility/Professional Facility Modifier 22 Low / Median / High Price $4,031.59 / $4,031.59 / $4,031.59	Facility	22	$4,031.59	$4,031.59	$4,031.59
Aetna Facility/Professional Facility Modifier 50 Low / Median / High Price $29,053.88 / $29,053.88 / $29,053.88	Facility	50	$29,053.88	$29,053.88	$29,053.88
Aetna Facility/Professional Professional Modifier Low / Median / High Price $505.13 / $771.26 / $2,288.00	Professional		$505.13	$771.26	$2,288.00
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $606.77 / $1,122.52 / $1,255.70	Professional		$606.77	$1,122.52	$1,255.70
Asuris Northwest Health Facility/Professional Facility Modifier Low / Median / High Price $3,403.52 / $5,468.48 / $11,500.00	Facility		$3,403.52	$5,468.48	$11,500.00
Asuris Northwest Health Facility/Professional Facility Modifier 50 Low / Median / High Price $5,971.22 / $8,207.42 / $15,878.12	Facility	50	$5,971.22	$8,207.42	$15,878.12
Asuris Northwest Health Facility/Professional Facility Modifier AS Low / Median / High Price $298.95 / $497.27 / $497.27	Facility	AS	$298.95	$497.27	$497.27
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $848.12 / $1,324.25 / $5,838.31	Professional		$848.12	$1,324.25	$5,838.31
Cigna Facility/Professional Facility Modifier Low / Median / High Price $625.25 / $761.81 / $2,190.81	Facility		$625.25	$761.81	$2,190.81
Cigna Facility/Professional Professional Modifier Low / Median / High Price $609.67 / $1,097.36 / $1,867.26	Professional		$609.67	$1,097.36	$1,867.26
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $602.91 / $1,229.60 / $2,003.94	Facility		$602.91	$1,229.60	$2,003.94
Kaiser Permanente Facility/Professional Facility Modifier 50 Low / Median / High Price $4,809.85 / $5,945.69 / $14,305.29	Facility	50	$4,809.85	$5,945.69	$14,305.29
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $571.54 / $1,221.58 / $1,789.24	Professional		$571.54	$1,221.58	$1,789.24
Molina Facility/Professional Professional Modifier Low / Median / High Price $93.33 / $642.30 / $1,367.41	Professional		$93.33	$642.30	$1,367.41
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $822.68 / $1,137.66 / $1,233.47	Facility		$822.68	$1,137.66	$1,233.47
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $598.07 / $809.06 / $1,795.87	Facility		$598.07	$809.06	$1,795.87
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $935.12 / $1,338.41 / $1,669.97	Professional		$935.12	$1,338.41	$1,669.97
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $3,913.81 / $5,468.48 / $10,466.57	Facility		$3,913.81	$5,468.48	$10,466.57
Regence BlueShield Facility/Professional Facility Modifier 50 Low / Median / High Price $5,870.72 / $8,202.71 / $15,699.86	Facility	50	$5,870.72	$8,202.71	$15,699.86
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $825.13 / $1,197.53 / $1,594.31	Professional		$825.13	$1,197.53	$1,594.31
United Facility/Professional Facility Modifier Low / Median / High Price $1,547.00 / $2,408.00 / $10,522.00	Facility		$1,547.00	$2,408.00	$10,522.00
United Facility/Professional Professional Modifier Low / Median / High Price $695.24 / $942.70 / $1,721.72	Professional		$695.24	$942.70	$1,721.72
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $513.48 / $513.48 / $675.11	Professional		$513.48	$513.48	$675.11