Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $49.74 / $79.56 / $105.50	Facility	26	$49.74	$79.56	$105.50
Aetna Facility/Professional Professional Modifier Low / Median / High Price $64.38 / $92.37 / $247.08	Professional		$64.38	$92.37	$247.08
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $37.39 / $49.74 / $88.97	Professional	26	$37.39	$49.74	$88.97
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $63.96 / $85.00 / $158.93	Facility	26	$63.96	$85.00	$158.93
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $71.40 / $143.94 / $590.48	Professional		$71.40	$143.94	$590.48
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $49.90 / $80.66 / $286.50	Professional	26	$49.90	$80.66	$286.50
Cigna Facility/Professional Professional Modifier Low / Median / High Price $70.06 / $121.68 / $238.17	Professional		$70.06	$121.68	$238.17
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $39.79 / $65.69 / $115.28	Professional	26	$39.79	$65.69	$115.28
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $34.11 / $50.29 / $95.23	Facility	26	$34.11	$50.29	$95.23
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $52.88 / $81.12 / $151.43	Professional		$52.88	$81.12	$151.43
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $33.79 / $49.64 / $88.54	Professional	26	$33.79	$49.64	$88.54
Molina Facility/Professional Professional Modifier Low / Median / High Price $14.62 / $62.33 / $145.57	Professional		$14.62	$62.33	$145.57
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $57.20 / $69.59 / $73.03	Facility	26	$57.20	$69.59	$73.03
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $34.74 / $69.68 / $86.11	Professional		$34.74	$69.68	$86.11
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $45.76 / $55.87 / $73.03	Professional	26	$45.76	$55.87	$73.03
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $48.92 / $48.92 / $48.92	Facility	26	$48.92	$48.92	$48.92
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $62.51 / $125.03 / $181.69	Professional		$62.51	$125.03	$181.69
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $55.80 / $83.20 / $93.87	Professional	26	$55.80	$83.20	$93.87
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 $96.02 / $126.05 / $174.30	Professional		$96.02	$126.05	$174.30
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $49.90 / $66.00 / $87.98	Professional	26	$49.90	$66.00	$87.98
United Facility/Professional Professional Modifier Low / Median / High Price $75.80 / $100.34 / $191.45	Professional		$75.80	$100.34	$191.45
United Facility/Professional Professional Modifier 26 Low / Median / High Price $43.85 / $58.31 / $106.46	Professional	26	$43.85	$58.31	$106.46
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $57.42 / $77.48 / $77.48	Professional		$57.42	$77.48	$77.48
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $28.98 / $36.96 / $36.96	Professional	26	$28.98	$36.96	$36.96