Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $1,253.29 / $9,305.92 / $23,000.00	Facility		$1,253.29	$9,305.92	$23,000.00
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $204.06 / $250.66 / $310.66	Facility	53	$204.06	$250.66	$310.66
Aetna Facility/Professional Facility Modifier 54 Low / Median / High Price $765.21 / $939.97 / $1,164.98	Facility	54	$765.21	$939.97	$1,164.98
Aetna Facility/Professional Facility Modifier 55 Low / Median / High Price $153.04 / $187.99 / $233.00	Facility	55	$153.04	$187.99	$233.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $584.94 / $776.50 / $1,553.00	Professional		$584.94	$776.50	$1,553.00
Aetna Facility/Professional Professional Modifier 55 Low / Median / High Price $91.45 / $153.04 / $260.50	Professional	55	$91.45	$153.04	$260.50
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $3,352.62 / $3,352.62 / $3,352.62	Professional		$3,352.62	$3,352.62	$3,352.62
Asuris Northwest Health Facility/Professional Facility Modifier Low / Median / High Price $894.68 / $14,482.75 / $28,332.57	Facility		$894.68	$14,482.75	$28,332.57
Asuris Northwest Health Facility/Professional Facility Modifier 53 Low / Median / High Price $2,430.46 / $4,042.62 / $4,042.62	Facility	53	$2,430.46	$4,042.62	$4,042.62
Asuris Northwest Health Facility/Professional Facility Modifier 54 Low / Median / High Price $8,506.60 / $14,149.17 / $14,149.17	Facility	54	$8,506.60	$14,149.17	$14,149.17
Asuris Northwest Health Facility/Professional Facility Modifier 55 Low / Median / High Price $1,822.84 / $3,031.96 / $3,031.96	Facility	55	$1,822.84	$3,031.96	$3,031.96
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $929.58 / $1,587.95 / $5,756.40	Professional		$929.58	$1,587.95	$5,756.40
Asuris Northwest Health Facility/Professional Professional Modifier 55 Low / Median / High Price $132.03 / $136.26 / $136.26	Professional	55	$132.03	$136.26	$136.26
Cigna Facility/Professional Facility Modifier Low / Median / High Price $734.00 / $734.00 / $8,905.29	Facility		$734.00	$734.00	$8,905.29
Cigna Facility/Professional Professional Modifier Low / Median / High Price $689.44 / $1,169.69 / $2,099.63	Professional		$689.44	$1,169.69	$2,099.63
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $867.24 / $1,681.68 / $7,809.64	Facility		$867.24	$1,681.68	$7,809.64
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $867.24 / $1,631.00 / $6,603.84	Professional		$867.24	$1,631.00	$6,603.84
Molina Facility/Professional Professional Modifier Low / Median / High Price $82.99 / $404.49 / $1,214.46	Professional		$82.99	$404.49	$1,214.46
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $892.32 / $1,333.40 / $1,358.76	Facility		$892.32	$1,333.40	$1,358.76
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $894.68 / $894.68 / $3,439.25	Facility		$894.68	$894.68	$3,439.25
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $953.97 / $1,526.37 / $1,839.60	Professional		$953.97	$1,526.37	$1,839.60
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $10,177.40 / $14,482.75 / $28,332.57	Facility		$10,177.40	$14,482.75	$28,332.57
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $912.45 / $1,328.17 / $2,081.73	Professional		$912.45	$1,328.17	$2,081.73
United Facility/Professional Facility Modifier Low / Median / High Price $2,263.00 / $2,912.00 / $16,315.00	Facility		$2,263.00	$2,912.00	$16,315.00
United Facility/Professional Professional Modifier Low / Median / High Price $869.00 / $1,103.30 / $1,905.71	Professional		$869.00	$1,103.30	$1,905.71