Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $25.23 / $40.31 / $55.07	Facility	26	$25.23	$40.31	$55.07
Aetna Facility/Professional Professional Modifier Low / Median / High Price $56.50 / $109.98 / $263.00	Professional		$56.50	$109.98	$263.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $18.07 / $25.23 / $52.22	Professional	26	$18.07	$25.23	$52.22
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $156.47 / $156.47 / $221.64	Professional		$156.47	$156.47	$221.64
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $33.43 / $33.43 / $37.47	Professional	26	$33.43	$33.43	$37.47
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $25.82 / $80.00 / $100.00	Facility	26	$25.82	$80.00	$100.00
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $110.42 / $168.69 / $655.58	Professional		$110.42	$168.69	$655.58
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $26.33 / $42.62 / $157.80	Professional	26	$26.33	$42.62	$157.80
Cigna Facility/Professional Professional Modifier Low / Median / High Price $72.88 / $131.56 / $248.46	Professional		$72.88	$131.56	$248.46
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $20.89 / $34.96 / $58.19	Professional	26	$20.89	$34.96	$58.19
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $19.60 / $34.79 / $47.28	Facility	26	$19.60	$34.79	$47.28
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $66.92 / $120.42 / $197.77	Professional		$66.92	$120.42	$197.77
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $19.51 / $34.79 / $48.87	Professional	26	$19.51	$34.79	$48.87
Molina Facility/Professional Professional Modifier Low / Median / High Price $18.24 / $100.92 / $181.74	Professional		$18.24	$100.92	$181.74
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $27.93 / $37.52 / $38.19	Facility	26	$27.93	$37.52	$38.19
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $22.91 / $32.46 / $38.19	Professional	26	$22.91	$32.46	$38.19
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $25.82 / $25.82 / $26.05	Facility	26	$25.82	$25.82	$26.05
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $113.89 / $172.86 / $211.94	Professional		$113.89	$172.86	$211.94
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $28.47 / $41.44 / $51.70	Professional	26	$28.47	$41.44	$51.70
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $110.42 / $149.35 / $201.89	Professional		$110.42	$149.35	$201.89
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $26.33 / $37.07 / $50.21	Professional	26	$26.33	$37.07	$50.21
United Facility/Professional Professional Modifier Low / Median / High Price $70.20 / $120.60 / $220.77	Professional		$70.20	$120.60	$220.77
United Facility/Professional Professional Modifier 26 Low / Median / High Price $23.94 / $31.36 / $55.05	Professional	26	$23.94	$31.36	$55.05
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $60.73 / $60.73 / $84.58	Professional		$60.73	$60.73	$84.58
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $15.74 / $15.74 / $20.26	Professional	26	$15.74	$15.74	$20.26