Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $95.63 / $188.09 / $308.12	Facility	26	$95.63	$188.09	$308.12
Aetna Facility/Professional Professional Modifier Low / Median / High Price $400.00 / $522.50 / $1,067.97	Professional		$400.00	$522.50	$1,067.97
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $86.37 / $140.00 / $268.64	Professional	26	$86.37	$140.00	$268.64
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $284.27 / $368.50 / $822.23	Professional	TC	$284.27	$368.50	$822.23
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $47.02 / $47.02 / $47.02	Professional	26	$47.02	$47.02	$47.02
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $789.92 / $789.92 / $789.92	Facility	26	$789.92	$789.92	$789.92
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $490.18 / $871.07 / $3,007.15	Professional		$490.18	$871.07	$3,007.15
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $115.96 / $200.70 / $848.54	Professional	26	$115.96	$200.70	$848.54
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $374.22 / $697.41 / $2,544.17	Professional	TC	$374.22	$697.41	$2,544.17
Cigna Facility/Professional Professional Modifier Low / Median / High Price $374.29 / $735.76 / $1,208.96	Professional		$374.29	$735.76	$1,208.96
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $83.86 / $153.31 / $265.61	Professional	26	$83.86	$153.31	$265.61
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $289.14 / $574.04 / $933.91	Professional	TC	$289.14	$574.04	$933.91
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $83.08 / $177.16 / $232.59	Facility	26	$83.08	$177.16	$232.59
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $436.48 / $872.46 / $1,417.21	Professional		$436.48	$872.46	$1,417.21
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $83.08 / $178.86 / $232.38	Professional	26	$83.08	$178.86	$232.38
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $358.05 / $687.23 / $1,163.77	Professional	TC	$358.05	$687.23	$1,163.77
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 $137.50 / $165.87 / $170.85	Facility	26	$137.50	$165.87	$170.85
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $116.28 / $145.35 / $180.18	Professional	26	$116.28	$145.35	$180.18
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $414.13 / $593.85 / $791.70	Professional	TC	$414.13	$593.85	$791.70
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $113.70 / $113.70 / $114.25	Facility	26	$113.70	$113.70	$114.25
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $543.85 / $818.11 / $989.13	Professional		$543.85	$818.11	$989.13
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $130.41 / $193.50 / $235.87	Professional	26	$130.41	$193.50	$235.87
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $413.43 / $621.26 / $758.96	Professional	TC	$413.43	$621.26	$758.96
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $490.18 / $718.99 / $1,050.30	Professional		$490.18	$718.99	$1,050.30
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $115.96 / $173.00 / $233.60	Professional	26	$115.96	$173.00	$233.60
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $374.22 / $545.99 / $809.91	Professional	TC	$374.22	$545.99	$809.91
United Facility/Professional Professional Modifier Low / Median / High Price $334.68 / $518.74 / $1,070.30	Professional		$334.68	$518.74	$1,070.30
United Facility/Professional Professional Modifier 26 Low / Median / High Price $77.61 / $102.00 / $240.34	Professional	26	$77.61	$102.00	$240.34
United Facility/Professional Professional Modifier TC Low / Median / High Price $257.07 / $431.95 / $845.32	Professional	TC	$257.07	$431.95	$845.32
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $392.53 / $392.53 / $392.53	Professional		$392.53	$392.53	$392.53
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $87.95 / $87.95 / $87.95	Professional	26	$87.95	$87.95	$87.95
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $304.57 / $304.57 / $304.57	Professional	TC	$304.57	$304.57	$304.57