Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $572.61 / $5,318.00 / $9,110.28	Facility		$572.61	$5,318.00	$9,110.28
Aetna Facility/Professional Facility Modifier 50 Low / Median / High Price $5,109.09 / $8,833.18 / $11,801.99	Facility	50	$5,109.09	$8,833.18	$11,801.99
Aetna Facility/Professional Professional Modifier Low / Median / High Price $368.06 / $572.61 / $2,019.00	Professional		$368.06	$572.61	$2,019.00
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $206.57 / $1,710.74 / $5,876.70	Professional	50	$206.57	$1,710.74	$5,876.70
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $407.84 / $798.05 / $910.46	Professional		$407.84	$798.05	$910.46
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $1,197.07 / $1,197.07 / $1,197.07	Professional	50	$1,197.07	$1,197.07	$1,197.07
Asuris Northwest Health Facility/Professional Facility Modifier Low / Median / High Price $2,079.40 / $5,468.48 / $11,500.00	Facility		$2,079.40	$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 Professional Modifier Low / Median / High Price $621.52 / $996.20 / $4,131.06	Professional		$621.52	$996.20	$4,131.06
Asuris Northwest Health Facility/Professional Professional Modifier 50 Low / Median / High Price $1,059.95 / $1,344.21 / $2,187.00	Professional	50	$1,059.95	$1,344.21	$2,187.00
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 $450.10 / $812.48 / $1,383.86	Professional		$450.10	$812.48	$1,383.86
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $413.54 / $860.47 / $1,644.07	Facility		$413.54	$860.47	$1,644.07
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 $413.54 / $852.00 / $1,398.72	Professional		$413.54	$852.00	$1,398.72
Molina Facility/Professional Professional Modifier Low / Median / High Price $85.04 / $476.46 / $1,031.05	Professional		$85.04	$476.46	$1,031.05
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $598.26 / $824.10 / $911.20	Facility		$598.26	$824.10	$911.20
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $598.07 / $598.87 / $1,795.87	Facility		$598.07	$598.87	$1,795.87
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $621.52 / $972.00 / $1,212.79	Professional		$621.52	$972.00	$1,212.79
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 $610.76 / $871.53 / $1,177.76	Professional		$610.76	$871.53	$1,177.76
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 $524.50 / $727.31 / $1,276.79	Professional		$524.50	$727.31	$1,276.79
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $378.76 / $492.14 / $501.22	Professional		$378.76	$492.14	$501.22