Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $65.06 / $114.88 / $210.27	Facility	26	$65.06	$114.88	$210.27
Aetna Facility/Professional Professional Modifier Low / Median / High Price $206.38 / $315.56 / $590.29	Professional		$206.38	$315.56	$590.29
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $52.46 / $69.50 / $154.79	Professional	26	$52.46	$69.50	$154.79
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $136.88 / $244.97 / $440.62	Professional	TC	$136.88	$244.97	$440.62
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $45.22 / $92.14 / $92.14	Professional	26	$45.22	$92.14	$92.14
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $540.32 / $540.32 / $540.32	Facility	26	$540.32	$540.32	$540.32
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $242.55 / $419.40 / $1,882.38	Professional		$242.55	$419.40	$1,882.38
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $79.45 / $141.43 / $474.38	Professional	26	$79.45	$141.43	$474.38
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $166.71 / $298.75 / $1,576.92	Professional	TC	$166.71	$298.75	$1,576.92
Cigna Facility/Professional Professional Modifier Low / Median / High Price $188.51 / $397.40 / $608.35	Professional		$188.51	$397.40	$608.35
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $57.38 / $105.02 / $181.76	Professional	26	$57.38	$105.02	$181.76
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $129.66 / $281.76 / $458.79	Professional	TC	$129.66	$281.76	$458.79
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $64.06 / $130.37 / $1,102.78	Facility	26	$64.06	$130.37	$1,102.78
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $244.59 / $457.04 / $790.14	Professional		$244.59	$457.04	$790.14
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $56.73 / $122.53 / $158.63	Professional	26	$56.73	$122.53	$158.63
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $178.69 / $333.20 / $611.55	Professional	TC	$178.69	$333.20	$611.55
Molina Facility/Professional Professional Modifier Low / Median / High Price $30.92 / $156.16 / $375.54	Professional		$30.92	$156.16	$375.54
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $93.99 / $112.96 / $116.58	Facility	26	$93.99	$112.96	$116.58
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $226.22 / $226.22 / $251.36	Professional		$226.22	$226.22	$251.36
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $69.95 / $104.40 / $130.50	Professional	26	$69.95	$104.40	$130.50
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $185.48 / $318.89 / $428.04	Professional	TC	$185.48	$318.89	$428.04
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $77.92 / $77.92 / $78.15	Facility	26	$77.92	$77.92	$78.15
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $270.12 / $408.66 / $499.82	Professional		$270.12	$408.66	$499.82
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $88.36 / $134.22 / $160.28	Professional	26	$88.36	$134.22	$160.28
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $181.46 / $274.02 / $339.77	Professional	TC	$181.46	$274.02	$339.77
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $714.15 / $714.15 / $1,538.06	Facility	26	$714.15	$714.15	$1,538.06
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $242.55 / $359.15 / $532.75	Professional		$242.55	$359.15	$532.75
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $79.45 / $118.33 / $160.03	Professional	26	$79.45	$118.33	$160.03
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $163.09 / $240.82 / $357.22	Professional	TC	$163.09	$240.82	$357.22
United Facility/Professional Professional Modifier Low / Median / High Price $168.72 / $290.01 / $541.74	Professional		$168.72	$290.01	$541.74
United Facility/Professional Professional Modifier 26 Low / Median / High Price $53.08 / $69.20 / $170.42	Professional	26	$53.08	$69.20	$170.42
United Facility/Professional Professional Modifier TC Low / Median / High Price $115.64 / $232.97 / $404.27	Professional	TC	$115.64	$232.97	$404.27
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $194.63 / $194.63 / $194.63	Professional		$194.63	$194.63	$194.63
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $59.90 / $59.90 / $59.90	Professional	26	$59.90	$59.90	$59.90
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $134.72 / $134.72 / $134.72	Professional	TC	$134.72	$134.72	$134.72