Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $92.53 / $153.00 / $298.72	Facility	26	$92.53	$153.00	$298.72
Aetna Facility/Professional Professional Modifier Low / Median / High Price $264.62 / $309.81 / $734.83	Professional		$264.62	$309.81	$734.83
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $73.00 / $92.53 / $214.50	Professional	26	$73.00	$92.53	$214.50
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $180.09 / $220.00 / $434.56	Professional	TC	$180.09	$220.00	$434.56
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $131.47 / $131.47 / $131.47	Professional	26	$131.47	$131.47	$131.47
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $346.39 / $768.32 / $768.32	Facility	26	$346.39	$768.32	$768.32
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $325.25 / $577.17 / $2,007.00	Professional		$325.25	$577.17	$2,007.00
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $113.19 / $194.36 / $673.05	Professional	26	$113.19	$194.36	$673.05
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $212.06 / $381.74 / $1,334.03	Professional	TC	$212.06	$381.74	$1,334.03
Cigna Facility/Professional Professional Modifier Low / Median / High Price $250.25 / $483.51 / $772.21	Professional		$250.25	$483.51	$772.21
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $81.77 / $148.37 / $258.36	Professional	26	$81.77	$148.37	$258.36
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $167.38 / $327.51 / $540.63	Professional	TC	$167.38	$327.51	$540.63
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $90.42 / $185.62 / $539.79	Facility	26	$90.42	$185.62	$539.79
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $282.54 / $572.76 / $759.42	Professional		$282.54	$572.76	$759.42
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $80.59 / $173.93 / $225.52	Professional	26	$80.59	$173.93	$225.52
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $212.66 / $399.28 / $556.05	Professional	TC	$212.66	$399.28	$556.05
Molina Facility/Professional Professional Modifier Low / Median / High Price $39.71 / $222.56 / $499.23	Professional		$39.71	$222.56	$499.23
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $133.65 / $161.22 / $165.49	Facility	26	$133.65	$161.22	$165.49
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $140.29 / $140.29 / $140.29	Professional		$140.29	$140.29	$140.29
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $98.89 / $139.90 / $174.14	Professional	26	$98.89	$139.90	$174.14
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $228.74 / $324.05 / $396.17	Professional	TC	$228.74	$324.05	$396.17
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $110.99 / $110.99 / $111.05	Facility	26	$110.99	$110.99	$111.05
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $362.40 / $553.75 / $694.27	Professional		$362.40	$553.75	$694.27
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $126.30 / $190.73 / $227.76	Professional	26	$126.30	$190.73	$227.76
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $236.10 / $360.77 / $465.29	Professional	TC	$236.10	$360.77	$465.29
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 $325.25 / $484.40 / $701.20	Professional		$325.25	$484.40	$701.20
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $113.19 / $166.97 / $227.17	Professional	26	$113.19	$166.97	$227.17
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $212.06 / $316.24 / $487.04	Professional	TC	$212.06	$316.24	$487.04
United Facility/Professional Professional Modifier Low / Median / High Price $215.04 / $322.45 / $682.83	Professional		$215.04	$322.45	$682.83
United Facility/Professional Professional Modifier 26 Low / Median / High Price $75.18 / $97.07 / $239.62	Professional	26	$75.18	$97.07	$239.62
United Facility/Professional Professional Modifier TC Low / Median / High Price $139.58 / $194.09 / $449.66	Professional	TC	$139.58	$194.09	$449.66
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $262.66 / $262.66 / $262.66	Professional		$262.66	$262.66	$262.66
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $85.44 / $85.44 / $85.44	Professional	26	$85.44	$85.44	$85.44
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $177.23 / $177.23 / $177.23	Professional	TC	$177.23	$177.23	$177.23