Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $96.79 / $158.75 / $311.83	Facility	26	$96.79	$158.75	$311.83
Aetna Facility/Professional Professional Modifier Low / Median / High Price $275.92 / $438.48 / $747.63	Professional		$275.92	$438.48	$747.63
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $82.23 / $96.79 / $208.59	Professional	26	$82.23	$96.79	$208.59
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $217.00 / $318.13 / $561.76	Professional	TC	$217.00	$318.13	$561.76
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $68.20 / $147.54 / $228.84	Professional	26	$68.20	$147.54	$228.84
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $346.39 / $801.92 / $801.92	Facility	26	$346.39	$801.92	$801.92
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $418.14 / $756.77 / $3,101.53	Professional		$418.14	$756.77	$3,101.53
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $117.35 / $210.83 / $705.75	Professional	26	$117.35	$210.83	$705.75
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $325.25 / $575.50 / $2,625.91	Professional	TC	$325.25	$575.50	$2,625.91
Cigna Facility/Professional Professional Modifier Low / Median / High Price $322.11 / $620.66 / $1,072.85	Professional		$322.11	$620.66	$1,072.85
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $85.43 / $156.46 / $269.68	Professional	26	$85.43	$156.46	$269.68
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $228.88 / $492.17 / $813.40	Professional	TC	$228.88	$492.17	$813.40
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $94.62 / $194.04 / $539.79	Facility	26	$94.62	$194.04	$539.79
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $322.17 / $686.03 / $1,200.50	Professional		$322.17	$686.03	$1,200.50
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $84.79 / $186.32 / $234.95	Professional	26	$84.79	$186.32	$234.95
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $262.70 / $512.22 / $950.68	Professional	TC	$262.70	$512.22	$950.68
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 $139.69 / $168.53 / $175.50	Facility	26	$139.69	$168.53	$175.50
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $107.74 / $153.90 / $196.73	Professional	26	$107.74	$153.90	$196.73
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $277.70 / $445.23 / $563.75	Professional	TC	$277.70	$445.23	$563.75
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $115.06 / $115.06 / $116.08	Facility	26	$115.06	$115.06	$116.08
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $492.82 / $740.94 / $899.50	Professional		$492.82	$740.94	$899.50
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $131.97 / $199.75 / $241.81	Professional	26	$131.97	$199.75	$241.81
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $360.85 / $540.94 / $660.82	Professional	TC	$360.85	$540.94	$660.82
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 $442.60 / $651.16 / $892.81	Professional		$442.60	$651.16	$892.81
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $117.35 / $175.77 / $236.36	Professional	26	$117.35	$175.77	$236.36
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $325.25 / $475.40 / $644.67	Professional	TC	$325.25	$475.40	$644.67
United Facility/Professional Professional Modifier Low / Median / High Price $279.16 / $502.87 / $962.12	Professional		$279.16	$502.87	$962.12
United Facility/Professional Professional Modifier 26 Low / Median / High Price $78.84 / $103.47 / $250.34	Professional	26	$78.84	$103.47	$250.34
United Facility/Professional Professional Modifier TC Low / Median / High Price $200.32 / $366.96 / $705.33	Professional	TC	$200.32	$366.96	$705.33
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $306.22 / $306.22 / $306.22	Professional		$306.22	$306.22	$306.22
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $89.42 / $89.42 / $89.42	Professional	26	$89.42	$89.42	$89.42
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $216.81 / $216.81 / $216.81	Professional	TC	$216.81	$216.81	$216.81