Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $65.06 / $128.68 / $211.62	Facility	26	$65.06	$128.68	$211.62
Aetna Facility/Professional Professional Modifier Low / Median / High Price $208.33 / $316.26 / $538.50	Professional		$208.33	$316.26	$538.50
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $52.78 / $69.84 / $162.56	Professional	26	$52.78	$69.84	$162.56
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $138.47 / $245.74 / $440.62	Professional	TC	$138.47	$245.74	$440.62
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $31.98 / $92.57 / $99.30	Professional	26	$31.98	$92.57	$99.30
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $542.79 / $542.79 / $542.79	Facility	26	$542.79	$542.79	$542.79
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $244.40 / $418.86 / $1,884.77	Professional		$244.40	$418.86	$1,884.77
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $79.93 / $143.59 / $478.50	Professional	26	$79.93	$143.59	$478.50
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $164.47 / $301.08 / $1,950.00	Professional	TC	$164.47	$301.08	$1,950.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $190.69 / $399.27 / $612.71	Professional		$190.69	$399.27	$612.71
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $57.49 / $105.02 / $182.60	Professional	26	$57.49	$105.02	$182.60
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $130.78 / $283.55 / $458.79	Professional	TC	$130.78	$283.55	$458.79
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $64.06 / $131.13 / $539.79	Facility	26	$64.06	$131.13	$539.79
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $245.52 / $459.84 / $796.03	Professional		$245.52	$459.84	$796.03
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $56.73 / $122.53 / $159.49	Professional	26	$56.73	$122.53	$159.49
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $180.67 / $336.73 / $611.55	Professional	TC	$180.67	$336.73	$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 $94.53 / $113.39 / $117.25	Facility	26	$94.53	$113.39	$117.25
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $155.88 / $155.88 / $231.04	Professional		$155.88	$155.88	$231.04
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $79.80 / $104.12 / $121.56	Professional	26	$79.80	$104.12	$121.56
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $208.34 / $288.52 / $436.01	Professional	TC	$208.34	$288.52	$436.01
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $78.37 / $78.37 / $78.59	Facility	26	$78.37	$78.37	$78.59
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $272.18 / $411.81 / $502.63	Professional		$272.18	$411.81	$502.63
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $88.87 / $134.22 / $161.22	Professional	26	$88.87	$134.22	$161.22
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $183.00 / $276.38 / $342.58	Professional	TC	$183.00	$276.38	$342.58
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 $244.40 / $361.92 / $536.86	Professional		$244.40	$361.92	$536.86
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $79.93 / $119.02 / $160.03	Professional	26	$79.93	$119.02	$160.03
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $164.47 / $242.89 / $360.30	Professional	TC	$164.47	$242.89	$360.30
United Facility/Professional Professional Modifier Low / Median / High Price $169.95 / $314.98 / $556.50	Professional		$169.95	$314.98	$556.50
United Facility/Professional Professional Modifier 26 Low / Median / High Price $53.07 / $66.45 / $165.47	Professional	26	$53.07	$66.45	$165.47
United Facility/Professional Professional Modifier TC Low / Median / High Price $116.88 / $198.12 / $375.28	Professional	TC	$116.88	$198.12	$375.28
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $196.48 / $196.48 / $196.48	Professional		$196.48	$196.48	$196.48
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $60.18 / $60.18 / $60.18	Professional	26	$60.18	$60.18	$60.18
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $136.30 / $136.30 / $136.30	Professional	TC	$136.30	$136.30	$136.30