Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $58.94 / $97.30 / $474.43	Facility	26	$58.94	$97.30	$474.43
Aetna Facility/Professional Professional Modifier Low / Median / High Price $189.65 / $264.24 / $429.23	Professional		$189.65	$264.24	$429.23
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $43.93 / $58.94 / $111.02	Professional	26	$43.93	$58.94	$111.02
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $144.19 / $208.75 / $318.20	Professional	TC	$144.19	$208.75	$318.20
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $158.22 / $383.48 / $429.96	Professional		$158.22	$383.48	$429.96
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $89.56 / $89.56 / $100.42	Professional	26	$89.56	$89.56	$100.42
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $109.01 / $234.66 / $234.66	Facility	26	$109.01	$234.66	$234.66
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $294.29 / $502.16 / $1,786.88	Professional		$294.29	$502.16	$1,786.88
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $71.61 / $124.29 / $430.80	Professional	26	$71.61	$124.29	$430.80
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $222.68 / $389.53 / $1,356.08	Professional	TC	$222.68	$389.53	$1,356.08
Cigna Facility/Professional Professional Modifier Low / Median / High Price $218.01 / $412.22 / $674.42	Professional		$218.01	$412.22	$674.42
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $52.44 / $96.15 / $164.63	Professional	26	$52.44	$96.15	$164.63
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $165.83 / $316.07 / $520.58	Professional	TC	$165.83	$316.07	$520.58
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $62.65 / $116.92 / $156.56	Facility	26	$62.65	$116.92	$156.56
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $251.75 / $472.51 / $632.00	Professional		$251.75	$472.51	$632.00
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $58.17 / $116.92 / $143.19	Professional	26	$58.17	$116.92	$143.19
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $188.88 / $370.66 / $493.06	Professional	TC	$188.88	$370.66	$493.06
Molina Facility/Professional Professional Modifier Low / Median / High Price $42.64 / $241.41 / $488.99	Professional		$42.64	$241.41	$488.99
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $85.19 / $102.28 / $105.40	Facility	26	$85.19	$102.28	$105.40
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $60.34 / $85.25 / $103.85	Professional	26	$60.34	$85.25	$103.85
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $248.58 / $298.14 / $311.55	Professional	TC	$248.58	$298.14	$311.55
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $70.22 / $70.22 / $70.84	Facility	26	$70.22	$70.22	$70.84
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $326.31 / $481.65 / $593.35	Professional		$326.31	$481.65	$593.35
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $80.14 / $121.66 / $147.56	Professional	26	$80.14	$121.66	$147.56
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $245.89 / $365.68 / $454.01	Professional	TC	$245.89	$365.68	$454.01
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $446.45 / $446.45 / $777.03	Facility	26	$446.45	$446.45	$777.03
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $294.29 / $425.71 / $590.20	Professional		$294.29	$425.71	$590.20
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $71.61 / $106.50 / $145.44	Professional	26	$71.61	$106.50	$145.44
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $222.68 / $321.77 / $453.66	Professional	TC	$222.68	$321.77	$453.66
United Facility/Professional Professional Modifier Low / Median / High Price $200.63 / $261.60 / $637.05	Professional		$200.63	$261.60	$637.05
United Facility/Professional Professional Modifier 26 Low / Median / High Price $48.47 / $61.92 / $153.90	Professional	26	$48.47	$61.92	$153.90
United Facility/Professional Professional Modifier TC Low / Median / High Price $152.16 / $203.36 / $483.16	Professional	TC	$152.16	$203.36	$483.16
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $232.41 / $232.41 / $232.41	Professional		$232.41	$232.41	$232.41
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $54.28 / $54.28 / $54.28	Professional	26	$54.28	$54.28	$54.28
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $178.13 / $178.13 / $178.13	Professional	TC	$178.13	$178.13	$178.13