Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $95.74 / $189.15 / $308.41	Facility	26	$95.74	$189.15	$308.41
Aetna Facility/Professional Professional Modifier Low / Median / High Price $320.49 / $475.00 / $877.78	Professional		$320.49	$475.00	$877.78
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $86.42 / $129.05 / $269.35	Professional	26	$86.42	$129.05	$269.35
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $225.06 / $335.00 / $608.42	Professional	TC	$225.06	$335.00	$608.42
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $136.59 / $136.59 / $164.39	Professional	26	$136.59	$136.59	$164.39
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $795.36 / $795.36 / $795.36	Facility	26	$795.36	$795.36	$795.36
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $388.45 / $681.57 / $3,482.54	Professional		$388.45	$681.57	$3,482.54
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $116.42 / $211.10 / $700.95	Professional	26	$116.42	$211.10	$700.95
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $284.58 / $503.81 / $2,996.90	Professional	TC	$284.58	$503.81	$2,996.90
Cigna Facility/Professional Professional Modifier Low / Median / High Price $304.95 / $611.91 / $1,067.05	Professional		$304.95	$611.91	$1,067.05
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $84.39 / $154.49 / $268.83	Professional	26	$84.39	$154.49	$268.83
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $219.15 / $434.65 / $819.87	Professional	TC	$219.15	$434.65	$819.87
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $93.89 / $192.68 / $1,102.78	Facility	26	$93.89	$192.68	$1,102.78
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $395.54 / $713.25 / $1,415.73	Professional		$395.54	$713.25	$1,415.73
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $84.63 / $184.87 / $234.44	Professional	26	$84.63	$184.87	$234.44
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $287.31 / $534.22 / $1,196.78	Professional	TC	$287.31	$534.22	$1,196.78
Molina Facility/Professional Professional Modifier Low / Median / High Price $56.10 / $268.38 / $603.77	Professional		$56.10	$268.38	$603.77
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $138.60 / $167.17 / $171.20	Facility	26	$138.60	$167.17	$171.20
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $115.82 / $163.19 / $192.41	Professional	26	$115.82	$163.19	$192.41
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $302.33 / $444.21 / $871.00	Professional	TC	$302.33	$444.21	$871.00
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $114.16 / $114.16 / $115.16	Facility	26	$114.16	$114.16	$115.16
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $443.85 / $669.29 / $843.34	Professional		$443.85	$669.29	$843.34
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $130.47 / $197.79 / $236.20	Professional	26	$130.47	$197.79	$236.20
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $312.91 / $470.87 / $601.11	Professional	TC	$312.91	$470.87	$601.11
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 $401.02 / $588.20 / $850.72	Professional		$401.02	$588.20	$850.72
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $116.42 / $174.38 / $234.52	Professional	26	$116.42	$174.38	$234.52
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $284.58 / $413.82 / $616.20	Professional	TC	$284.58	$413.82	$616.20
United Facility/Professional Professional Modifier Low / Median / High Price $272.41 / $544.33 / $907.50	Professional		$272.41	$544.33	$907.50
United Facility/Professional Professional Modifier 26 Low / Median / High Price $77.92 / $102.74 / $250.20	Professional	26	$77.92	$102.74	$250.20
United Facility/Professional Professional Modifier TC Low / Median / High Price $194.49 / $400.42 / $639.79	Professional	TC	$194.49	$400.42	$639.79
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $318.95 / $318.95 / $318.95	Professional		$318.95	$318.95	$318.95
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $88.86 / $88.86 / $88.86	Professional	26	$88.86	$88.86	$88.86
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $230.11 / $230.11 / $230.11	Professional	TC	$230.11	$230.11	$230.11