Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $153.41 / $2,295.23 / $6,789.94	Facility		$153.41	$2,295.23	$6,789.94
Aetna Facility/Professional Facility Modifier 52 Low / Median / High Price $74.48 / $148.94 / $167.13	Facility	52	$74.48	$148.94	$167.13
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $59.57 / $122.62 / $238.28	Facility	53	$59.57	$122.62	$238.28
Aetna Facility/Professional Professional Modifier Low / Median / High Price $161.24 / $297.87 / $572.66	Professional		$161.24	$297.87	$572.66
Aetna Facility/Professional Professional Modifier 53 Low / Median / High Price $37.11 / $87.17 / $226.08	Professional	53	$37.11	$87.17	$226.08
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $177.83 / $293.42 / $356.61	Professional		$177.83	$293.42	$356.61
Ambetter Facility/Professional Professional Modifier 53 Low / Median / High Price $167.47 / $167.47 / $181.57	Professional	53	$167.47	$167.47	$181.57
Asuris Northwest Health Facility/Professional Facility Modifier Low / Median / High Price $671.06 / $2,590.05 / $16,394.00	Facility		$671.06	$2,590.05	$16,394.00
Asuris Northwest Health Facility/Professional Facility Modifier 52 Low / Median / High Price $268.89 / $664.86 / $664.86	Facility	52	$268.89	$664.86	$664.86
Asuris Northwest Health Facility/Professional Facility Modifier 53 Low / Median / High Price $67.22 / $166.21 / $166.21	Facility	53	$67.22	$166.21	$166.21
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $294.02 / $624.14 / $2,208.13	Professional		$294.02	$624.14	$2,208.13
Asuris Northwest Health Facility/Professional Professional Modifier 53 Low / Median / High Price $130.08 / $238.85 / $431.46	Professional	53	$130.08	$238.85	$431.46
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 $301.75 / $301.75 / $301.75	Professional		$301.75	$301.75	$301.75
Cigna Facility/Professional Professional Modifier 53 Low / Median / High Price $106.08 / $144.07 / $268.16	Professional	53	$106.08	$144.07	$268.16
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 / $196.47 / $388.48	Facility	53	$91.68	$196.47	$388.48
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $259.68 / $483.24 / $904.55	Professional		$259.68	$483.24	$904.55
Kaiser Permanente Facility/Professional Professional Modifier 53 Low / Median / High Price $91.68 / $196.47 / $366.02	Professional	53	$91.68	$196.47	$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 $362.70 / $662.81 / $702.82	Facility		$362.70	$662.81	$702.82
Pacific Source Facility/Professional Facility Modifier 53 Low / Median / High Price $278.58 / $364.48 / $696.32	Facility	53	$278.58	$364.48	$696.32
Pacific Source Facility/Professional Professional Modifier 53 Low / Median / High Price $233.92 / $386.57 / $686.08	Professional	53	$233.92	$386.57	$686.08
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $422.54 / $467.95 / $671.06	Facility		$422.54	$467.95	$671.06
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $294.63 / $494.51 / $882.50	Professional		$294.63	$494.51	$882.50
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 $282.08 / $477.25 / $774.69	Professional		$282.08	$477.25	$774.69
Regence BlueShield Facility/Professional Professional Modifier 53 Low / Median / High Price $136.32 / $238.85 / $387.35	Professional	53	$136.32	$238.85	$387.35
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 $353.17 / $565.79 / $984.81	Professional		$353.17	$565.79	$984.81
United Facility/Professional Professional Modifier 53 Low / Median / High Price $204.84 / $204.84 / $204.84	Professional	53	$204.84	$204.84	$204.84
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $279.93 / $279.93 / $279.93	Professional		$279.93	$279.93	$279.93
Wellpoint Facility/Professional Professional Modifier 53 Low / Median / High Price $139.97 / $139.97 / $139.97	Professional	53	$139.97	$139.97	$139.97