Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $195.29 / $414.40 / $679.23	Facility	26	$195.29	$414.40	$679.23
Aetna Facility/Professional Professional Modifier Low / Median / High Price $580.76 / $640.30 / $1,272.48	Professional		$580.76	$640.30	$1,272.48
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $181.68 / $204.99 / $444.03	Professional	26	$181.68	$204.99	$444.03
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $546.01 / $546.01 / $546.01	Professional		$546.01	$546.01	$546.01
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $262.74 / $915.88 / $1,374.41	Facility	26	$262.74	$915.88	$1,374.41
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $808.04 / $1,415.12 / $5,226.45	Professional		$808.04	$1,415.12	$5,226.45
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $271.45 / $468.68 / $1,652.85	Professional	26	$271.45	$468.68	$1,652.85
Cigna Facility/Professional Professional Modifier Low / Median / High Price $737.90 / $1,245.46 / $1,965.91	Professional		$737.90	$1,245.46	$1,965.91
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $244.06 / $400.32 / $634.09	Professional	26	$244.06	$400.32	$634.09
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $185.07 / $451.88 / $2,160.25	Facility	26	$185.07	$451.88	$2,160.25
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $597.99 / $1,330.85 / $1,729.73	Professional		$597.99	$1,330.85	$1,729.73
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $187.11 / $430.86 / $535.32	Professional	26	$187.11	$430.86	$535.32
Molina Facility/Professional Professional Modifier Low / Median / High Price $113.28 / $542.08 / $1,275.12	Professional		$113.28	$542.08	$1,275.12
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $271.95 / $381.90 / $397.98	Facility	26	$271.95	$381.90	$397.98
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $490.08 / $490.08 / $599.05	Professional		$490.08	$490.08	$599.05
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $229.14 / $308.37 / $407.34	Professional	26	$229.14	$308.37	$407.34
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $262.74 / $262.74 / $271.45	Facility	26	$262.74	$262.74	$271.45
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $923.12 / $1,385.10 / $1,652.98	Professional		$923.12	$1,385.10	$1,652.98
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $305.64 / $452.81 / $541.87	Professional	26	$305.64	$452.81	$541.87
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $1,374.41 / $1,374.41 / $2,406.69	Facility	26	$1,374.41	$1,374.41	$2,406.69
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $808.04 / $1,244.65 / $1,632.03	Professional		$808.04	$1,244.65	$1,632.03
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $267.95 / $406.89 / $533.53	Professional	26	$267.95	$406.89	$533.53
United Facility/Professional Professional Modifier Low / Median / High Price $734.93 / $765.55 / $1,638.32	Professional		$734.93	$765.55	$1,638.32
United Facility/Professional Professional Modifier 26 Low / Median / High Price $236.14 / $257.14 / $515.40	Professional	26	$236.14	$257.14	$515.40
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $699.85 / $699.85 / $699.85	Professional		$699.85	$699.85	$699.85
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $215.09 / $215.09 / $215.09	Professional	26	$215.09	$215.09	$215.09