Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $84.88 / $168.56 / $269.87	Facility	26	$84.88	$168.56	$269.87
Aetna Facility/Professional Professional Modifier Low / Median / High Price $155.55 / $210.52 / $466.82	Professional		$155.55	$210.52	$466.82
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $67.59 / $84.88 / $199.54	Professional	26	$67.59	$84.88	$199.54
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $171.80 / $171.80 / $171.80	Professional		$171.80	$171.80	$171.80
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $159.52 / $211.40 / $343.65	Facility	26	$159.52	$211.40	$343.65
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $239.32 / $447.00 / $1,504.80	Professional		$239.32	$447.00	$1,504.80
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $104.73 / $189.32 / $626.17	Professional	26	$104.73	$189.32	$626.17
Cigna Facility/Professional Professional Modifier Low / Median / High Price $184.66 / $315.55 / $562.85	Professional		$184.66	$315.55	$562.85
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $82.28 / $137.16 / $229.94	Professional	26	$82.28	$137.16	$229.94
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $72.84 / $157.77 / $263.95	Facility	26	$72.84	$157.77	$263.95
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $162.08 / $343.75 / $456.31	Professional		$162.08	$343.75	$456.31
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $72.84 / $154.84 / $195.47	Professional	26	$72.84	$154.84	$195.47
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.48 / $186.70 / $424.37	Professional		$32.48	$186.70	$424.37
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $113.27 / $148.74 / $151.41	Facility	26	$113.27	$148.74	$151.41
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $86.94 / $86.94 / $86.94	Professional		$86.94	$86.94	$86.94
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $101.23 / $130.07 / $165.02	Professional	26	$101.23	$130.07	$165.02
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $101.02 / $101.02 / $103.28	Facility	26	$101.02	$101.02	$103.28
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $269.61 / $401.73 / $493.96	Professional		$269.61	$401.73	$493.96
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $116.50 / $172.28 / $211.83	Professional	26	$116.50	$172.28	$211.83
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $211.40 / $211.40 / $385.75	Facility	26	$211.40	$211.40	$385.75
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $239.32 / $346.45 / $466.66	Professional		$239.32	$346.45	$466.66
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $103.03 / $149.63 / $202.99	Professional	26	$103.03	$149.63	$202.99
United Facility/Professional Professional Modifier Low / Median / High Price $176.62 / $194.95 / $476.82	Professional		$176.62	$194.95	$476.82
United Facility/Professional Professional Modifier 26 Low / Median / High Price $76.59 / $84.25 / $214.71	Professional	26	$76.59	$84.25	$214.71
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $197.08 / $197.08 / $197.08	Professional		$197.08	$197.08	$197.08
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $80.11 / $80.11 / $80.11	Professional	26	$80.11	$80.11	$80.11