Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $100.17 / $165.01 / $326.12	Facility	26	$100.17	$165.01	$326.12
Aetna Facility/Professional Professional Modifier Low / Median / High Price $279.42 / $438.26 / $688.45	Professional		$279.42	$438.26	$688.45
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $82.39 / $100.17 / $243.22	Professional	26	$82.39	$100.17	$243.22
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $217.13 / $317.89 / $561.19	Professional	TC	$217.13	$317.89	$561.19
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $143.04 / $160.38 / $171.88	Professional	26	$143.04	$160.38	$171.88
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $346.39 / $833.76 / $833.76	Facility	26	$346.39	$833.76	$833.76
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $419.08 / $794.00 / $2,878.66	Professional		$419.08	$794.00	$2,878.66
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $121.97 / $219.02 / $732.83	Professional	26	$121.97	$219.02	$732.83
Asuris Northwest Health Facility/Professional Professional Modifier 50 Low / Median / High Price $484.62 / $548.15 / $1,116.10	Professional	50	$484.62	$548.15	$1,116.10
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $344.77 / $605.21 / $2,400.63	Professional	TC	$344.77	$605.21	$2,400.63
Cigna Facility/Professional Professional Modifier Low / Median / High Price $353.33 / $650.16 / $1,114.92	Professional		$353.33	$650.16	$1,114.92
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $88.46 / $161.94 / $280.36	Professional	26	$88.46	$161.94	$280.36
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $259.81 / $508.16 / $875.79	Professional	TC	$259.81	$508.16	$875.79
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $99.04 / $201.62 / $539.79	Facility	26	$99.04	$201.62	$539.79
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $352.63 / $775.24 / $1,215.63	Professional		$352.63	$775.24	$1,215.63
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $87.73 / $189.42 / $244.38	Professional	26	$87.73	$189.42	$244.38
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $294.81 / $576.83 / $930.10	Professional	TC	$294.81	$576.83	$930.10
Molina Facility/Professional Professional Modifier Low / Median / High Price $48.08 / $248.09 / $578.88	Professional		$48.08	$248.09	$578.88
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $143.10 / $175.21 / $180.90	Facility	26	$143.10	$175.21	$180.90
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $155.88 / $270.36 / $270.36	Professional		$155.88	$270.36	$270.36
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $119.84 / $153.33 / $193.05	Professional	26	$119.84	$153.33	$193.05
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $344.25 / $483.72 / $655.98	Professional	TC	$344.25	$483.72	$655.98
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $119.59 / $119.59 / $120.65	Facility	26	$119.59	$119.59	$120.65
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $519.62 / $782.68 / $946.29	Professional		$519.62	$782.68	$946.29
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $136.36 / $207.21 / $247.45	Professional	26	$136.36	$207.21	$247.45
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $382.50 / $574.79 / $706.24	Professional	TC	$382.50	$574.79	$706.24
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 $467.54 / $687.85 / $941.37	Professional		$467.54	$687.85	$941.37
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $121.97 / $182.69 / $247.40	Professional	26	$121.97	$182.69	$247.40
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $345.58 / $505.16 / $685.03	Professional	TC	$345.58	$505.16	$685.03
United Facility/Professional Professional Modifier Low / Median / High Price $306.77 / $446.05 / $974.09	Professional		$306.77	$446.05	$974.09
United Facility/Professional Professional Modifier 26 Low / Median / High Price $81.59 / $105.46 / $254.40	Professional	26	$81.59	$105.46	$254.40
United Facility/Professional Professional Modifier TC Low / Median / High Price $225.17 / $358.98 / $723.00	Professional	TC	$225.17	$358.98	$723.00
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $309.58 / $309.58 / $309.58	Professional		$309.58	$309.58	$309.58
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $92.91 / $92.91 / $92.91	Professional	26	$92.91	$92.91	$92.91
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $216.69 / $216.69 / $216.69	Professional	TC	$216.69	$216.69	$216.69