Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $60.46 / $99.82 / $194.78	Facility	26	$60.46	$99.82	$194.78
Aetna Facility/Professional Professional Modifier Low / Median / High Price $171.00 / $265.33 / $429.12	Professional		$171.00	$265.33	$429.12
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $48.57 / $60.47 / $146.51	Professional	26	$48.57	$60.47	$146.51
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $117.26 / $208.43 / $354.57	Professional	TC	$117.26	$208.43	$354.57
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $29.48 / $91.87 / $91.87	Professional	26	$29.48	$91.87	$91.87
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $502.08 / $502.08 / $502.08	Facility	26	$502.08	$502.08	$502.08
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $208.39 / $364.12 / $1,547.04	Professional		$208.39	$364.12	$1,547.04
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $73.45 / $132.18 / $441.68	Professional	26	$73.45	$132.18	$441.68
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $139.06 / $250.95 / $1,263.33	Professional	TC	$139.06	$250.95	$1,263.33
Cigna Facility/Professional Professional Modifier Low / Median / High Price $162.08 / $314.20 / $533.95	Professional		$162.08	$314.20	$533.95
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $53.15 / $97.58 / $168.91	Professional	26	$53.15	$97.58	$168.91
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $105.76 / $213.30 / $371.71	Professional	TC	$105.76	$213.30	$371.71
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $59.64 / $121.28 / $539.79	Facility	26	$59.64	$121.28	$539.79
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $196.14 / $355.86 / $655.94	Professional		$196.14	$355.86	$655.94
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $53.01 / $114.08 / $147.49	Professional	26	$53.01	$114.08	$147.49
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $128.59 / $250.73 / $492.21	Professional	TC	$128.59	$250.73	$492.21
Molina Facility/Professional Professional Modifier Low / Median / High Price $29.46 / $149.27 / $312.59	Professional		$29.46	$149.27	$312.59
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $87.39 / $104.95 / $107.87	Facility	26	$87.39	$104.95	$107.87
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $140.29 / $140.29 / $155.88	Professional		$140.29	$140.29	$155.88
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $67.62 / $92.17 / $112.54	Professional	26	$67.62	$92.17	$112.54
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $134.55 / $198.99 / $337.44	Professional	TC	$134.55	$198.99	$337.44
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $72.03 / $72.03 / $72.66	Facility	26	$72.03	$72.03	$72.66
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $236.61 / $359.05 / $436.88	Professional		$236.61	$359.05	$436.88
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $82.12 / $123.07 / $149.03	Professional	26	$82.12	$123.07	$149.03
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $154.13 / $233.86 / $289.22	Professional	TC	$154.13	$233.86	$289.22
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $346.39 / $346.39 / $851.78	Facility	26	$346.39	$346.39	$851.78
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $212.52 / $315.55 / $428.66	Professional		$212.52	$315.55	$428.66
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $73.45 / $110.03 / $148.99	Professional	26	$73.45	$110.03	$148.99
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $139.06 / $205.52 / $283.30	Professional	TC	$139.06	$205.52	$283.30
United Facility/Professional Professional Modifier Low / Median / High Price $140.80 / $240.04 / $452.11	Professional		$140.80	$240.04	$452.11
United Facility/Professional Professional Modifier 26 Low / Median / High Price $49.08 / $64.31 / $155.84	Professional	26	$49.08	$64.31	$155.84
United Facility/Professional Professional Modifier TC Low / Median / High Price $91.72 / $188.84 / $328.05	Professional	TC	$91.72	$188.84	$328.05
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $171.07 / $171.07 / $171.07	Professional		$171.07	$171.07	$171.07
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $55.68 / $55.68 / $55.68	Professional	26	$55.68	$55.68	$55.68
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $115.39 / $115.39 / $115.39	Professional	TC	$115.39	$115.39	$115.39