Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $103.26 / $194.47 / $358.93	Facility	26	$103.26	$194.47	$358.93
Aetna Facility/Professional Professional Modifier Low / Median / High Price $393.25 / $477.32 / $1,008.00	Professional		$393.25	$477.32	$1,008.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $90.71 / $109.42 / $241.39	Professional	26	$90.71	$109.42	$241.39
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $302.52 / $374.06 / $720.85	Professional	TC	$302.52	$374.06	$720.85
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $208.72 / $208.72 / $208.72	Professional	26	$208.72	$208.72	$208.72
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $139.52 / $479.89 / $479.89	Facility	26	$139.52	$479.89	$479.89
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $571.49 / $973.60 / $3,528.98	Professional		$571.49	$973.60	$3,528.98
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $143.04 / $245.76 / $870.53	Professional	26	$143.04	$245.76	$870.53
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $429.20 / $731.44 / $2,658.53	Professional	TC	$429.20	$731.44	$2,658.53
Cigna Facility/Professional Professional Modifier Low / Median / High Price $565.05 / $880.30 / $1,333.49	Professional		$565.05	$880.30	$1,333.49
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $128.69 / $211.38 / $334.24	Professional	26	$128.69	$211.38	$334.24
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $442.10 / $661.47 / $1,016.33	Professional	TC	$442.10	$661.47	$1,016.33
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $97.03 / $194.70 / $280.66	Facility	26	$97.03	$194.70	$280.66
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $470.27 / $956.59 / $1,255.31	Professional		$470.27	$956.59	$1,255.31
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $98.25 / $226.52 / $280.66	Professional	26	$98.25	$226.52	$280.66
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $373.24 / $742.73 / $996.31	Professional	TC	$373.24	$742.73	$996.31
Molina Facility/Professional Professional Modifier Low / Median / High Price $80.97 / $355.16 / $878.01	Professional		$80.97	$355.16	$878.01
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $156.35 / $203.01 / $209.71	Facility	26	$156.35	$203.01	$209.71
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $116.58 / $171.10 / $209.71	Professional	26	$116.58	$171.10	$209.71
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $399.19 / $566.01 / $688.76	Professional	TC	$399.19	$566.01	$688.76
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $139.52 / $139.52 / $143.04	Facility	26	$139.52	$139.52	$143.04
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $637.16 / $940.47 / $1,148.19	Professional		$637.16	$940.47	$1,148.19
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $160.27 / $238.60 / $285.48	Professional	26	$160.27	$238.60	$285.48
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $476.32 / $705.89 / $854.82	Professional	TC	$476.32	$705.89	$854.82
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $571.49 / $847.70 / $1,149.54	Professional		$571.49	$847.70	$1,149.54
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $142.30 / $214.41 / $281.14	Professional	26	$142.30	$214.41	$281.14
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $429.20 / $631.10 / $874.84	Professional	TC	$429.20	$631.10	$874.84
United Facility/Professional Professional Modifier Low / Median / High Price $523.55 / $576.08 / $1,113.28	Professional		$523.55	$576.08	$1,113.28
United Facility/Professional Professional Modifier 26 Low / Median / High Price $129.86 / $136.69 / $270.26	Professional	26	$129.86	$136.69	$270.26
United Facility/Professional Professional Modifier TC Low / Median / High Price $391.40 / $439.39 / $844.29	Professional	TC	$391.40	$439.39	$844.29
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $464.07 / $464.07 / $464.07	Professional		$464.07	$464.07	$464.07
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $112.82 / $112.82 / $112.82	Professional	26	$112.82	$112.82	$112.82
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $351.26 / $351.26 / $351.26	Professional	TC	$351.26	$351.26	$351.26