Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $95.94 / $190.15 / $310.47	Facility	26	$95.94	$190.15	$310.47
Aetna Facility/Professional Professional Modifier Low / Median / High Price $400.00 / $475.00 / $1,062.31	Professional		$400.00	$475.00	$1,062.31
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $86.55 / $129.13 / $269.89	Professional	26	$86.55	$129.13	$269.89
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $281.79 / $361.04 / $792.41	Professional	TC	$281.79	$361.04	$792.41
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $140.60 / $140.60 / $140.60	Professional	26	$140.60	$140.60	$140.60
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $795.52 / $795.52 / $795.52	Facility	26	$795.52	$795.52	$795.52
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $487.41 / $871.79 / $3,018.44	Professional		$487.41	$871.79	$3,018.44
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $116.42 / $201.07 / $850.86	Professional	26	$116.42	$201.07	$850.86
Asuris Northwest Health Facility/Professional Professional Modifier 50 Low / Median / High Price $566.97 / $685.61 / $1,472.70	Professional	50	$566.97	$685.61	$1,472.70
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $370.99 / $673.46 / $2,546.60	Professional	TC	$370.99	$673.46	$2,546.60
Cigna Facility/Professional Professional Modifier Low / Median / High Price $372.99 / $733.94 / $1,204.77	Professional		$372.99	$733.94	$1,204.77
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $84.52 / $154.51 / $267.48	Professional	26	$84.52	$154.51	$267.48
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $287.30 / $569.02 / $927.98	Professional	TC	$287.30	$569.02	$927.98
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $83.70 / $178.56 / $234.44	Facility	26	$83.70	$178.56	$234.44
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $439.27 / $870.32 / $1,421.62	Professional		$439.27	$870.32	$1,421.62
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $83.70 / $180.27 / $233.24	Professional	26	$83.70	$180.27	$233.24
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $360.22 / $680.35 / $1,170.83	Professional	TC	$360.22	$680.35	$1,170.83
Molina Facility/Professional Professional Modifier Low / Median / High Price $73.20 / $318.25 / $770.64	Professional		$73.20	$318.25	$770.64
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $138.60 / $167.21 / $172.19	Facility	26	$138.60	$167.21	$172.19
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $103.31 / $146.49 / $178.89	Professional	26	$103.31	$146.49	$178.89
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $374.26 / $586.91 / $794.02	Professional	TC	$374.26	$586.91	$794.02
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 $540.76 / $815.75 / $986.27	Professional		$540.76	$815.75	$986.27
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $130.47 / $195.05 / $236.81	Professional	26	$130.47	$195.05	$236.81
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $409.82 / $617.32 / $756.68	Professional	TC	$409.82	$617.32	$756.68
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $487.41 / $716.91 / $1,044.78	Professional		$487.41	$716.91	$1,044.78
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $116.42 / $174.38 / $235.44	Professional	26	$116.42	$174.38	$235.44
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $370.99 / $542.53 / $804.78	Professional	TC	$370.99	$542.53	$804.78
United Facility/Professional Professional Modifier Low / Median / High Price $333.75 / $498.02 / $1,054.58	Professional		$333.75	$498.02	$1,054.58
United Facility/Professional Professional Modifier 26 Low / Median / High Price $78.23 / $100.66 / $245.57	Professional	26	$78.23	$100.66	$245.57
United Facility/Professional Professional Modifier TC Low / Median / High Price $255.52 / $408.16 / $820.49	Professional	TC	$255.52	$408.16	$820.49
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $392.41 / $392.41 / $392.41	Professional		$392.41	$392.41	$392.41
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $88.63 / $88.63 / $88.63	Professional	26	$88.63	$88.63	$88.63
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $303.77 / $303.77 / $303.77	Professional	TC	$303.77	$303.77	$303.77