Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $55.45 / $80.98 / $119.69	Facility	26	$55.45	$80.98	$119.69
Aetna Facility/Professional Professional Modifier Low / Median / High Price $109.45 / $172.48 / $353.54	Professional		$109.45	$172.48	$353.54
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $31.56 / $50.59 / $108.79	Professional	26	$31.56	$50.59	$108.79
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $79.54 / $130.56 / $250.33	Professional	TC	$79.54	$130.56	$250.33
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $38.29 / $78.14 / $93.96	Professional	26	$38.29	$78.14	$93.96
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $102.26 / $219.49 / $219.49	Facility	26	$102.26	$219.49	$219.49
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $210.22 / $382.85 / $1,320.15	Professional		$210.22	$382.85	$1,320.15
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $65.20 / $115.00 / $402.00	Professional	26	$65.20	$115.00	$402.00
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $143.96 / $254.10 / $918.15	Professional	TC	$143.96	$254.10	$918.15
Cigna Facility/Professional Professional Modifier Low / Median / High Price $146.57 / $279.14 / $494.28	Professional		$146.57	$279.14	$494.28
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $36.84 / $71.81 / $145.33	Professional	26	$36.84	$71.81	$145.33
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $106.56 / $202.38 / $351.05	Professional	TC	$106.56	$202.38	$351.05
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $40.79 / $76.75 / $490.69	Facility	26	$40.79	$76.75	$490.69
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $149.25 / $300.69 / $427.72	Professional		$149.25	$300.69	$427.72
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $36.76 / $72.69 / $119.00	Professional	26	$36.76	$72.69	$119.00
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $118.42 / $231.68 / $331.85	Professional	TC	$118.42	$231.68	$331.85
Molina Facility/Professional Professional Modifier Low / Median / High Price $29.46 / $148.77 / $312.97	Professional		$29.46	$148.77	$312.97
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $56.43 / $93.42 / $98.49	Facility	26	$56.43	$93.42	$98.49
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $39.40 / $55.86 / $98.49	Professional	26	$39.40	$55.86	$98.49
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $128.63 / $185.86 / $229.60	Professional	TC	$128.63	$185.86	$229.60
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $66.14 / $66.14 / $66.27	Facility	26	$66.14	$66.14	$66.27
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $239.90 / $356.04 / $436.18	Professional		$239.90	$356.04	$436.18
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $71.81 / $114.03 / $138.04	Professional	26	$71.81	$114.03	$138.04
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $157.90 / $247.72 / $299.52	Professional	TC	$157.90	$247.72	$299.52
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 $218.53 / $316.11 / $426.62	Professional		$218.53	$316.11	$426.62
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $67.45 / $99.33 / $136.07	Professional	26	$67.45	$99.33	$136.07
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $156.96 / $217.98 / $299.82	Professional	TC	$156.96	$217.98	$299.82
United Facility/Professional Professional Modifier Low / Median / High Price $147.56 / $174.08 / $428.91	Professional		$147.56	$174.08	$428.91
United Facility/Professional Professional Modifier 26 Low / Median / High Price $35.77 / $54.43 / $137.72	Professional	26	$35.77	$54.43	$137.72
United Facility/Professional Professional Modifier TC Low / Median / High Price $103.58 / $125.60 / $292.63	Professional	TC	$103.58	$125.60	$292.63
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $171.82 / $171.82 / $171.82	Professional		$171.82	$171.82	$171.82
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $50.79 / $50.79 / $50.79	Professional	26	$50.79	$50.79	$50.79
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $121.03 / $121.03 / $121.03	Professional	TC	$121.03	$121.03	$121.03