Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $47.87 / $64.80 / $101.56	Facility	26	$47.87	$64.80	$101.56
Aetna Facility/Professional Professional Modifier Low / Median / High Price $68.54 / $93.42 / $171.60	Professional		$68.54	$93.42	$171.60
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $32.72 / $39.82 / $76.70	Professional	26	$32.72	$39.82	$76.70
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $102.60 / $146.99 / $162.18	Professional		$102.60	$146.99	$162.18
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $63.67 / $63.67 / $71.39	Professional	26	$63.67	$63.67	$71.39
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $49.83 / $165.02 / $165.02	Facility	26	$49.83	$165.02	$165.02
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $87.65 / $168.59 / $707.70	Professional		$87.65	$168.59	$707.70
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $40.77 / $75.06 / $300.14	Professional	26	$40.77	$75.06	$300.14
Asuris Northwest Health Facility/Professional Professional Modifier 50 Low / Median / High Price $129.94 / $200.92 / $369.36	Professional	50	$129.94	$200.92	$369.36
Cigna Facility/Professional Professional Modifier Low / Median / High Price $84.63 / $137.05 / $253.39	Professional		$84.63	$137.05	$253.39
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $39.09 / $65.42 / $108.63	Professional	26	$39.09	$65.42	$108.63
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $32.76 / $53.47 / $90.19	Facility	26	$32.76	$53.47	$90.19
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $71.12 / $112.32 / $203.27	Professional		$71.12	$112.32	$203.27
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $30.52 / $49.05 / $87.68	Professional	26	$30.52	$49.05	$87.68
Molina Facility/Professional Professional Modifier Low / Median / High Price $15.78 / $69.66 / $224.30	Professional		$15.78	$69.66	$224.30
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $52.92 / $71.98 / $73.03	Facility	26	$52.92	$71.98	$73.03
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $43.42 / $53.77 / $76.14	Professional	26	$43.42	$53.77	$76.14
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $49.36 / $49.36 / $49.83	Facility	26	$49.36	$49.36	$49.83
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $116.66 / $187.08 / $229.37	Professional		$116.66	$187.08	$229.37
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $51.62 / $81.56 / $97.97	Professional	26	$51.62	$81.56	$97.97
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $118.73 / $162.59 / $219.60	Professional		$118.73	$162.59	$219.60
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $50.82 / $70.26 / $95.63	Professional	26	$50.82	$70.26	$95.63
United Facility/Professional Professional Modifier Low / Median / High Price $100.72 / $151.61 / $241.09	Professional		$100.72	$151.61	$241.09
United Facility/Professional Professional Modifier 26 Low / Median / High Price $40.86 / $64.31 / $108.49	Professional	26	$40.86	$64.31	$108.49
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $67.36 / $81.09 / $91.87	Professional		$67.36	$81.09	$91.87
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $30.09 / $35.68 / $38.59	Professional	26	$30.09	$35.68	$38.59