Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $148.76 / $2,491.40 / $8,500.00	Facility		$148.76	$2,491.40	$8,500.00
Aetna Facility/Professional Facility Modifier 52 Low / Median / High Price $74.38 / $88.79 / $148.84	Facility	52	$74.38	$88.79	$148.84
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $59.53 / $122.29 / $237.96	Facility	53	$59.53	$122.29	$237.96
Aetna Facility/Professional Professional Modifier Low / Median / High Price $164.50 / $297.67 / $556.34	Professional		$164.50	$297.67	$556.34
Aetna Facility/Professional Professional Modifier 53 Low / Median / High Price $37.04 / $85.12 / $225.52	Professional	53	$37.04	$85.12	$225.52
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $173.16 / $284.11 / $361.88	Professional		$173.16	$284.11	$361.88
Asuris Northwest Health Facility/Professional Facility Modifier Low / Median / High Price $671.06 / $2,588.57 / $16,394.00	Facility		$671.06	$2,588.57	$16,394.00
Asuris Northwest Health Facility/Professional Facility Modifier 52 Low / Median / High Price $268.70 / $663.66 / $663.66	Facility	52	$268.70	$663.66	$663.66
Asuris Northwest Health Facility/Professional Facility Modifier 53 Low / Median / High Price $67.18 / $165.92 / $165.92	Facility	53	$67.18	$165.92	$165.92
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $293.49 / $623.53 / $2,206.53	Professional		$293.49	$623.53	$2,206.53
Asuris Northwest Health Facility/Professional Professional Modifier 53 Low / Median / High Price $129.60 / $238.39 / $430.61	Professional	53	$129.60	$238.39	$430.61
Cigna Facility/Professional Facility Modifier Low / Median / High Price $625.25 / $761.81 / $1,159.36	Facility		$625.25	$761.81	$1,159.36
Cigna Facility/Professional Professional Modifier Low / Median / High Price $301.45 / $301.45 / $301.45	Professional		$301.45	$301.45	$301.45
Cigna Facility/Professional Professional Modifier 53 Low / Median / High Price $106.08 / $143.83 / $267.63	Professional	53	$106.08	$143.83	$267.63
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $275.87 / $513.40 / $1,016.72	Facility		$275.87	$513.40	$1,016.72
Kaiser Permanente Facility/Professional Facility Modifier 53 Low / Median / High Price $91.68 / $195.75 / $386.12	Facility	53	$91.68	$195.75	$386.12
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $259.20 / $482.75 / $904.55	Professional		$259.20	$482.75	$904.55
Kaiser Permanente Facility/Professional Professional Modifier 53 Low / Median / High Price $91.68 / $195.75 / $366.02	Professional	53	$91.68	$195.75	$366.02
Molina Facility/Professional Professional Modifier Low / Median / High Price $68.16 / $357.21 / $723.75	Professional		$68.16	$357.21	$723.75
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $369.36 / $662.38 / $702.82	Facility		$369.36	$662.38	$702.82
Pacific Source Facility/Professional Facility Modifier 53 Low / Median / High Price $278.05 / $363.14 / $695.64	Facility	53	$278.05	$363.14	$695.64
Pacific Source Facility/Professional Professional Modifier 53 Low / Median / High Price $217.20 / $373.98 / $687.99	Professional	53	$217.20	$373.98	$687.99
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $422.54 / $467.50 / $671.06	Facility		$422.54	$467.50	$671.06
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $294.08 / $493.60 / $881.64	Professional		$294.08	$493.60	$881.64
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $1,780.56 / $2,590.05 / $4,954.47	Facility		$1,780.56	$2,590.05	$4,954.47
Regence BlueShield Facility/Professional Facility Modifier 53 Low / Median / High Price $1,539.68 / $1,539.68 / $2,392.77	Facility	53	$1,539.68	$1,539.68	$2,392.77
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $281.57 / $476.78 / $773.93	Professional		$281.57	$476.78	$773.93
Regence BlueShield Facility/Professional Professional Modifier 53 Low / Median / High Price $135.82 / $238.39 / $386.59	Professional	53	$135.82	$238.39	$386.59
United Facility/Professional Facility Modifier Low / Median / High Price $425.00 / $887.00 / $4,611.00	Facility		$425.00	$887.00	$4,611.00
United Facility/Professional Professional Modifier Low / Median / High Price $373.56 / $583.41 / $968.05	Professional		$373.56	$583.41	$968.05
United Facility/Professional Professional Modifier 53 Low / Median / High Price $204.61 / $204.61 / $204.61	Professional	53	$204.61	$204.61	$204.61
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $279.66 / $279.66 / $279.66	Professional		$279.66	$279.66	$279.66
Wellpoint Facility/Professional Professional Modifier 53 Low / Median / High Price $139.69 / $139.69 / $139.69	Professional	53	$139.69	$139.69	$139.69