Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $64.64 / $127.17 / $210.27	Facility	26	$64.64	$127.17	$210.27
Aetna Facility/Professional Professional Modifier Low / Median / High Price $238.82 / $350.87 / $622.37	Professional		$238.82	$350.87	$622.37
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $52.78 / $69.09 / $128.88	Professional	26	$52.78	$69.09	$128.88
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $169.73 / $285.00 / $541.57	Professional	TC	$169.73	$285.00	$541.57
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $31.48 / $31.48 / $31.48	Professional	26	$31.48	$31.48	$31.48
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $537.20 / $537.20 / $537.20	Facility	26	$537.20	$537.20	$537.20
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $280.89 / $504.42 / $2,082.64	Professional		$280.89	$504.42	$2,082.64
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $79.45 / $139.91 / $471.45	Professional	26	$79.45	$139.91	$471.45
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $202.74 / $381.65 / $1,754.89	Professional	TC	$202.74	$381.65	$1,754.89
Cigna Facility/Professional Professional Modifier Low / Median / High Price $218.80 / $465.28 / $731.06	Professional		$218.80	$465.28	$731.06
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $57.04 / $104.41 / $180.66	Professional	26	$57.04	$104.41	$180.66
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $160.02 / $352.55 / $588.71	Professional	TC	$160.02	$352.55	$588.71
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $70.93 / $129.61 / $539.79	Facility	26	$70.93	$129.61	$539.79
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $273.16 / $537.41 / $920.05	Professional		$273.16	$537.41	$920.05
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $63.69 / $128.02 / $157.78	Professional	26	$63.69	$128.02	$157.78
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $228.87 / $416.23 / $776.18	Professional	TC	$228.87	$416.23	$776.18
Molina Facility/Professional Professional Modifier Low / Median / High Price $36.60 / $201.84 / $457.79	Professional		$36.60	$201.84	$457.79
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $93.44 / $112.30 / $116.58	Facility	26	$93.44	$112.30	$116.58
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $140.29 / $140.29 / $140.29	Professional		$140.29	$140.29	$140.29
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $69.59 / $105.16 / $128.76	Professional	26	$69.59	$105.16	$128.76
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $253.94 / $361.20 / $572.85	Professional	TC	$253.94	$361.20	$572.85
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $77.69 / $77.69 / $77.92	Facility	26	$77.69	$77.69	$77.92
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $312.91 / $473.23 / $576.58	Professional		$312.91	$473.23	$576.58
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $87.84 / $133.43 / $159.34	Professional	26	$87.84	$133.43	$159.34
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $224.76 / $343.44 / $417.46	Professional	TC	$224.76	$343.44	$417.46
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 $280.89 / $415.89 / $616.92	Professional		$280.89	$415.89	$616.92
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $79.45 / $117.64 / $159.11	Professional	26	$79.45	$117.64	$159.11
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $201.43 / $298.25 / $457.85	Professional	TC	$201.43	$298.25	$457.85
United Facility/Professional Professional Modifier Low / Median / High Price $201.24 / $353.17 / $639.79	Professional		$201.24	$353.17	$639.79
United Facility/Professional Professional Modifier 26 Low / Median / High Price $52.76 / $68.80 / $169.97	Professional	26	$52.76	$68.80	$169.97
United Facility/Professional Professional Modifier TC Low / Median / High Price $148.47 / $300.13 / $471.47	Professional	TC	$148.47	$300.13	$471.47
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $226.59 / $226.59 / $226.59	Professional		$226.59	$226.59	$226.59
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $59.51 / $59.51 / $59.51	Professional	26	$59.51	$59.51	$59.51
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $167.08 / $167.08 / $167.08	Professional	TC	$167.08	$167.08	$167.08