Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $40.70 / $63.95 / $119.11	Facility		$40.70	$63.95	$119.11
Aetna Facility/Professional Facility Modifier 25 Low / Median / High Price $50.53 / $194.53 / $357.42	Facility	25	$50.53	$194.53	$357.42
Aetna Facility/Professional Professional Modifier Low / Median / High Price $27.45 / $49.68 / $100.57	Professional		$27.45	$49.68	$100.57
Aetna Facility/Professional Professional Modifier 25 Low / Median / High Price $33.82 / $61.99 / $145.75	Professional	25	$33.82	$61.99	$145.75
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $52.42 / $75.68 / $112.12	Professional		$52.42	$75.68	$112.12
Ambetter Facility/Professional Professional Modifier 25 Low / Median / High Price $49.33 / $75.68 / $115.61	Professional	25	$49.33	$75.68	$115.61
Asuris Northwest Health Facility/Professional Facility Modifier Low / Median / High Price $50.00 / $158.93 / $158.93	Facility		$50.00	$158.93	$158.93
Asuris Northwest Health Facility/Professional Facility Modifier 62 Low / Median / High Price $41.18 / $99.33 / $99.33	Facility	62	$41.18	$99.33	$99.33
Asuris Northwest Health Facility/Professional Facility Modifier AS Low / Median / High Price $6.59 / $15.89 / $15.89	Facility	AS	$6.59	$15.89	$15.89
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $48.55 / $94.50 / $354.09	Professional		$48.55	$94.50	$354.09
Asuris Northwest Health Facility/Professional Professional Modifier 25 Low / Median / High Price $43.98 / $71.20 / $122.63	Professional	25	$43.98	$71.20	$122.63
Asuris Northwest Health Facility/Professional Professional Modifier 50 Low / Median / High Price $61.04 / $71.95 / $89.51	Professional	50	$61.04	$71.95	$89.51
Cigna Facility/Professional Facility Modifier Low / Median / High Price $74.01 / $125.00 / $148.00	Facility		$74.01	$125.00	$148.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $29.99 / $67.53 / $147.65	Professional		$29.99	$67.53	$147.65
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $28.51 / $54.84 / $107.16	Facility		$28.51	$54.84	$107.16
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $28.51 / $54.84 / $112.54	Professional		$28.51	$54.84	$112.54
Molina Facility/Professional Professional Modifier Low / Median / High Price $18.45 / $104.57 / $185.15	Professional		$18.45	$104.57	$185.15
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $51.46 / $93.44 / $113.90	Facility		$51.46	$93.44	$113.90
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $75.20 / $75.20 / $75.20	Facility		$75.20	$75.20	$75.20
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $57.01 / $91.36 / $144.35	Professional		$57.01	$91.36	$144.35
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $48.55 / $79.75 / $131.58	Professional		$48.55	$79.75	$131.58
United Facility/Professional Professional Modifier Low / Median / High Price $48.63 / $76.79 / $162.19	Professional		$48.63	$76.79	$162.19
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $36.83 / $46.93 / $62.49	Professional		$36.83	$46.93	$62.49