Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $1,656.26 / $8,955.00 / $23,000.00	Facility		$1,656.26	$8,955.00	$23,000.00
Aetna Facility/Professional Facility Modifier 54 Low / Median / High Price $1,018.54 / $1,488.26 / $1,943.54	Facility	54	$1,018.54	$1,488.26	$1,943.54
Aetna Facility/Professional Professional Modifier Low / Median / High Price $738.41 / $956.37 / $2,163.32	Professional		$738.41	$956.37	$2,163.32
Aetna Facility/Professional Professional Modifier 55 Low / Median / High Price $117.40 / $203.71 / $388.71	Professional	55	$117.40	$203.71	$388.71
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $1,002.86 / $1,002.86 / $1,002.86	Professional		$1,002.86	$1,002.86	$1,002.86
Asuris Northwest Health Facility/Professional Facility Modifier Low / Median / High Price $1,223.39 / $6,603.99 / $14,605.02	Facility		$1,223.39	$6,603.99	$14,605.02
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 Professional Modifier Low / Median / High Price $1,235.83 / $2,201.16 / $7,601.03	Professional		$1,235.83	$2,201.16	$7,601.03
Asuris Northwest Health Facility/Professional Professional Modifier 55 Low / Median / High Price $347.67 / $347.67 / $358.81	Professional	55	$347.67	$347.67	$358.81
Cigna Facility/Professional Facility Modifier Low / Median / High Price $1,185.00 / $1,185.00 / $2,876.24	Facility		$1,185.00	$1,185.00	$2,876.24
Cigna Facility/Professional Professional Modifier Low / Median / High Price $903.64 / $1,438.27 / $2,769.10	Professional		$903.64	$1,438.27	$2,769.10
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $1,101.31 / $1,467.34 / $2,630.91	Facility		$1,101.31	$1,467.34	$2,630.91
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $1,101.31 / $1,467.34 / $2,537.34	Professional		$1,101.31	$1,467.34	$2,537.34
Molina Facility/Professional Professional Modifier Low / Median / High Price $78.89 / $508.06 / $1,770.49	Professional		$78.89	$508.06	$1,770.49
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $1,262.73 / $1,717.88 / $1,793.59	Facility		$1,262.73	$1,717.88	$1,793.59
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $1,126.18 / $1,184.14 / $1,223.39	Facility		$1,126.18	$1,184.14	$1,223.39
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $1,259.26 / $2,017.91 / $2,428.31	Professional		$1,259.26	$2,017.91	$2,428.31
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 Professional Modifier Low / Median / High Price $1,207.67 / $1,759.86 / $2,298.27	Professional		$1,207.67	$1,759.86	$2,298.27
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 $1,041.04 / $1,408.15 / $2,519.41	Professional		$1,041.04	$1,408.15	$2,519.41