Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $1,366.75 / $7,920.26 / $20,680.40	Facility		$1,366.75	$7,920.26	$20,680.40
Aetna Facility/Professional Facility Modifier 50 Low / Median / High Price $2,630.26 / $12,839.96 / $12,839.96	Facility	50	$2,630.26	$12,839.96	$12,839.96
Aetna Facility/Professional Facility Modifier 54 Low / Median / High Price $839.64 / $1,228.11 / $1,699.75	Facility	54	$839.64	$1,228.11	$1,699.75
Aetna Facility/Professional Facility Modifier 55 Low / Median / High Price $167.93 / $245.62 / $339.95	Facility	55	$167.93	$245.62	$339.95
Aetna Facility/Professional Professional Modifier Low / Median / High Price $830.58 / $1,119.52 / $3,240.00	Professional		$830.58	$1,119.52	$3,240.00
Aetna Facility/Professional Professional Modifier 54 Low / Median / High Price $521.48 / $839.64 / $1,699.75	Professional	54	$521.48	$839.64	$1,699.75
Aetna Facility/Professional Professional Modifier 55 Low / Median / High Price $104.30 / $167.93 / $339.95	Professional	55	$104.30	$167.93	$339.95
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $980.26 / $1,002.86 / $1,365.11	Professional		$980.26	$1,002.86	$1,365.11
Asuris Northwest Health Facility/Professional Facility Modifier Low / Median / High Price $1,126.18 / $6,603.99 / $14,605.02	Facility		$1,126.18	$6,603.99	$14,605.02
Asuris Northwest Health Facility/Professional Facility Modifier 50 Low / Median / High Price $7,554.80 / $9,905.99 / $19,164.18	Facility	50	$7,554.80	$9,905.99	$19,164.18
Asuris Northwest Health Facility/Professional Facility Modifier 54 Low / Median / High Price $2,747.48 / $4,569.92 / $4,569.92	Facility	54	$2,747.48	$4,569.92	$4,569.92
Asuris Northwest Health Facility/Professional Facility Modifier 55 Low / Median / High Price $588.75 / $979.27 / $979.27	Facility	55	$588.75	$979.27	$979.27
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $1,020.07 / $1,732.81 / $6,925.00	Professional		$1,020.07	$1,732.81	$6,925.00
Asuris Northwest Health Facility/Professional Professional Modifier 54 Low / Median / High Price $611.29 / $1,149.98 / $1,186.82	Professional	54	$611.29	$1,149.98	$1,186.82
Asuris Northwest Health Facility/Professional Professional Modifier 55 Low / Median / High Price $287.50 / $287.50 / $296.70	Professional	55	$287.50	$287.50	$296.70
Cigna Facility/Professional Facility Modifier Low / Median / High Price $1,398.00 / $1,398.00 / $2,876.24	Facility		$1,398.00	$1,398.00	$2,876.24
Cigna Facility/Professional Professional Modifier Low / Median / High Price $790.39 / $1,340.97 / $2,299.88	Professional		$790.39	$1,340.97	$2,299.88
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $994.25 / $1,452.18 / $2,522.36	Facility		$994.25	$1,452.18	$2,522.36
Kaiser Permanente Facility/Professional Facility Modifier 50 Low / Median / High Price $5,875.62 / $6,463.64 / $16,692.80	Facility	50	$5,875.62	$6,463.64	$16,692.80
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $994.25 / $1,452.18 / $2,287.50	Professional		$994.25	$1,452.18	$2,287.50
Molina Facility/Professional Professional Modifier Low / Median / High Price $78.68 / $420.53 / $1,452.65	Professional		$78.68	$420.53	$1,452.65
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $1,177.23 / $1,450.77 / $1,619.16	Facility		$1,177.23	$1,450.77	$1,619.16
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $976.67 / $976.67 / $1,077.93	Facility		$976.67	$976.67	$1,077.93
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $1,040.05 / $1,665.61 / $2,005.60	Professional		$1,040.05	$1,665.61	$2,005.60
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $4,818.83 / $6,600.21 / $12,632.68	Facility		$4,818.83	$6,600.21	$12,632.68
Regence BlueShield Facility/Professional Facility Modifier 50 Low / Median / High Price $7,228.25 / $9,900.32 / $18,949.02	Facility	50	$7,228.25	$9,900.32	$18,949.02
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $996.07 / $1,453.51 / $1,957.84	Professional		$996.07	$1,453.51	$1,957.84
United Facility/Professional Facility Modifier Low / Median / High Price $1,224.00 / $1,862.00 / $10,522.00	Facility		$1,224.00	$1,862.00	$10,522.00
United Facility/Professional Professional Modifier Low / Median / High Price $954.00 / $1,271.98 / $2,095.10	Professional		$954.00	$1,271.98	$2,095.10