Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $450.18 / $1,021.38 / $1,564.47	Facility	26	$450.18	$1,021.38	$1,564.47
Aetna Facility/Professional Professional Modifier Low / Median / High Price $740.75 / $950.56 / $2,070.92	Professional		$740.75	$950.56	$2,070.92
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $450.18 / $540.38 / $1,056.18	Professional	26	$450.18	$540.38	$1,056.18
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $607.92 / $4,331.35 / $4,331.35	Facility	26	$607.92	$4,331.35	$4,331.35
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $1,221.07 / $2,146.48 / $7,886.55	Professional		$1,221.07	$2,146.48	$7,886.55
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $626.09 / $1,077.57 / $5,024.00	Professional	26	$626.09	$1,077.57	$5,024.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,058.10 / $1,827.41 / $2,936.60	Professional		$1,058.10	$1,827.41	$2,936.60
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $563.16 / $959.29 / $1,462.39	Professional	26	$563.16	$959.29	$1,462.39
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $509.64 / $1,051.64 / $2,160.25	Facility	26	$509.64	$1,051.64	$2,160.25
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $864.85 / $1,777.28 / $2,370.13	Professional		$864.85	$1,777.28	$2,370.13
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $509.64 / $991.06 / $1,346.70	Professional	26	$509.64	$991.06	$1,346.70
Molina Facility/Professional Professional Modifier Low / Median / High Price $144.61 / $859.38 / $1,966.13	Professional		$144.61	$859.38	$1,966.13
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $681.58 / $889.76 / $1,024.42	Facility	26	$681.58	$889.76	$1,024.42
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $490.08 / $490.08 / $544.53	Professional		$490.08	$490.08	$544.53
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $540.12 / $810.57 / $1,097.46	Professional	26	$540.12	$810.57	$1,097.46
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $607.92 / $607.92 / $626.09	Facility	26	$607.92	$607.92	$626.09
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $1,399.83 / $2,106.23 / $2,506.32	Professional		$1,399.83	$2,106.23	$2,506.32
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $705.20 / $1,044.34 / $1,245.83	Professional	26	$705.20	$1,044.34	$1,245.83
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 $1,221.07 / $1,870.76 / $2,481.73	Professional		$1,221.07	$1,870.76	$2,481.73
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $620.00 / $938.45 / $1,230.53	Professional	26	$620.00	$938.45	$1,230.53
United Facility/Professional Professional Modifier Low / Median / High Price $986.41 / $1,107.95 / $2,427.15	Professional		$986.41	$1,107.95	$2,427.15
United Facility/Professional Professional Modifier 26 Low / Median / High Price $569.50 / $696.50 / $1,247.22	Professional	26	$569.50	$696.50	$1,247.22
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $1,050.65 / $1,050.65 / $1,050.65	Professional		$1,050.65	$1,050.65	$1,050.65
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $495.73 / $495.73 / $495.73	Professional	26	$495.73	$495.73	$495.73