Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $64.33 / $126.67 / $207.92	Facility	26	$64.33	$126.67	$207.92
Aetna Facility/Professional Professional Modifier Low / Median / High Price $290.10 / $475.00 / $912.45	Professional		$290.10	$475.00	$912.45
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $62.50 / $126.00 / $207.92	Professional	26	$62.50	$126.00	$207.92
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $216.24 / $335.00 / $619.40	Professional	TC	$216.24	$335.00	$619.40
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $31.29 / $91.06 / $102.10	Professional	26	$31.29	$91.06	$102.10
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $446.45 / $530.79 / $530.79	Facility	26	$446.45	$530.79	$530.79
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $312.77 / $560.95 / $2,961.02	Professional		$312.77	$560.95	$2,961.02
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $78.54 / $136.34 / $505.24	Professional	26	$78.54	$136.34	$505.24
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $243.36 / $453.36 / $2,631.72	Professional	TC	$243.36	$453.36	$2,631.72
Cigna Facility/Professional Professional Modifier Low / Median / High Price $243.07 / $564.17 / $934.92	Professional		$243.07	$564.17	$934.92
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $56.60 / $103.81 / $178.54	Professional	26	$56.60	$103.81	$178.54
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $184.28 / $433.06 / $771.28	Professional	TC	$184.28	$433.06	$771.28
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $63.33 / $128.86 / $698.97	Facility	26	$63.33	$128.86	$698.97
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $350.14 / $662.65 / $1,306.25	Professional		$350.14	$662.65	$1,306.25
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $56.11 / $121.12 / $155.97	Professional	26	$56.11	$121.12	$155.97
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $299.97 / $541.52 / $1,169.61	Professional	TC	$299.97	$541.52	$1,169.61
Molina Facility/Professional Professional Modifier Low / Median / High Price $42.36 / $239.82 / $486.63	Professional		$42.36	$239.82	$486.63
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $92.40 / $111.62 / $115.24	Facility	26	$92.40	$111.62	$115.24
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $160.34 / $160.34 / $160.34	Professional		$160.34	$160.34	$160.34
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $80.84 / $103.72 / $121.26	Professional	26	$80.84	$103.72	$121.26
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $268.91 / $484.57 / $814.05	Professional	TC	$268.91	$484.57	$814.05
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $76.78 / $76.78 / $77.01	Facility	26	$76.78	$76.78	$77.01
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $346.93 / $524.41 / $656.14	Professional		$346.93	$524.41	$656.14
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $87.33 / $132.12 / $159.94	Professional	26	$87.33	$132.12	$159.94
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $259.30 / $396.21 / $497.95	Professional	TC	$259.30	$396.21	$497.95
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $446.45 / $446.45 / $782.93	Facility	26	$446.45	$446.45	$782.93
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $312.77 / $460.87 / $711.29	Professional		$312.77	$460.87	$711.29
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $78.54 / $116.26 / $158.19	Professional	26	$78.54	$116.26	$158.19
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $234.23 / $344.62 / $531.86	Professional	TC	$234.23	$344.62	$531.86
United Facility/Professional Professional Modifier Low / Median / High Price $212.59 / $437.68 / $758.27	Professional		$212.59	$437.68	$758.27
United Facility/Professional Professional Modifier 26 Low / Median / High Price $52.46 / $68.37 / $166.56	Professional	26	$52.46	$68.37	$166.56
United Facility/Professional Professional Modifier TC Low / Median / High Price $160.13 / $329.68 / $577.70	Professional	TC	$160.13	$329.68	$577.70
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $251.84 / $251.84 / $251.84	Professional		$251.84	$251.84	$251.84
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $59.23 / $59.23 / $59.23	Professional	26	$59.23	$59.23	$59.23
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $192.62 / $192.62 / $192.62	Professional	TC	$192.62	$192.62	$192.62