Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $57.99 / $92.80 / $120.16	Facility	26	$57.99	$92.80	$120.16
Aetna Facility/Professional Professional Modifier Low / Median / High Price $65.20 / $100.59 / $180.50	Professional		$65.20	$100.59	$180.50
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $42.25 / $57.99 / $117.25	Professional	26	$42.25	$57.99	$117.25
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $104.80 / $104.80 / $104.80	Professional		$104.80	$104.80	$104.80
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $72.06 / $96.12 / $184.67	Facility	26	$72.06	$96.12	$184.67
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $104.61 / $171.06 / $641.33	Professional		$104.61	$171.06	$641.33
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $57.29 / $91.76 / $334.50	Professional	26	$57.29	$91.76	$334.50
Cigna Facility/Professional Professional Modifier Low / Median / High Price $77.16 / $134.88 / $258.01	Professional		$77.16	$134.88	$258.01
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $46.10 / $76.36 / $133.93	Professional	26	$46.10	$76.36	$133.93
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $39.11 / $57.81 / $106.33	Facility	26	$39.11	$57.81	$106.33
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $58.19 / $89.28 / $166.32	Professional		$58.19	$89.28	$166.32
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $38.75 / $56.93 / $102.27	Professional	26	$38.75	$56.93	$102.27
Molina Facility/Professional Professional Modifier Low / Median / High Price $15.32 / $61.87 / $144.23	Professional		$15.32	$61.87	$144.23
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $66.55 / $80.70 / $83.08	Facility	26	$66.55	$80.70	$83.08
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $49.20 / $66.55 / $83.08	Professional	26	$49.20	$66.55	$83.08
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $55.30 / $56.17 / $56.17	Facility	26	$55.30	$56.17	$56.17
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $112.89 / $171.36 / $205.00	Professional		$112.89	$171.36	$205.00
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $63.62 / $92.24 / $109.81	Professional	26	$63.62	$92.24	$109.81
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $72.06 / $72.06 / $127.19	Facility	26	$72.06	$72.06	$127.19
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $104.90 / $136.96 / $190.07	Professional		$104.90	$136.96	$190.07
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $57.29 / $76.20 / $102.92	Professional	26	$57.29	$76.20	$102.92
United Facility/Professional Professional Modifier Low / Median / High Price $83.16 / $109.63 / $208.78	Professional		$83.16	$109.63	$208.78
United Facility/Professional Professional Modifier 26 Low / Median / High Price $50.41 / $69.11 / $121.70	Professional	26	$50.41	$69.11	$121.70
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $62.39 / $83.84 / $83.84	Professional		$62.39	$83.84	$83.84
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $33.68 / $42.92 / $42.92	Professional	26	$33.68	$42.92	$42.92