Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $100.15 / $189.44 / $348.21	Facility	26	$100.15	$189.44	$348.21
Aetna Facility/Professional Professional Modifier Low / Median / High Price $293.74 / $368.72 / $785.20	Professional		$293.74	$368.72	$785.20
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $89.57 / $102.65 / $212.45	Professional	26	$89.57	$102.65	$212.45
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $204.15 / $268.57 / $537.14	Professional	TC	$204.15	$268.57	$537.14
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $86.42 / $203.34 / $204.13	Professional	26	$86.42	$203.34	$204.13
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $135.90 / $469.26 / $1,374.41	Facility	26	$135.90	$469.26	$1,374.41
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $469.85 / $814.48 / $3,009.98	Professional		$469.85	$814.48	$3,009.98
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $139.38 / $239.46 / $848.48	Professional	26	$139.38	$239.46	$848.48
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $331.25 / $575.02 / $2,161.50	Professional	TC	$331.25	$575.02	$2,161.50
Cigna Facility/Professional Professional Modifier Low / Median / High Price $417.46 / $700.65 / $1,134.99	Professional		$417.46	$700.65	$1,134.99
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $125.46 / $206.52 / $325.64	Professional	26	$125.46	$206.52	$325.64
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $289.08 / $492.37 / $809.90	Professional	TC	$289.08	$492.37	$809.90
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $94.55 / $231.19 / $2,160.25	Facility	26	$94.55	$231.19	$2,160.25
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $329.79 / $726.74 / $931.67	Professional		$329.79	$726.74	$931.67
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $95.43 / $220.40 / $273.49	Professional	26	$95.43	$220.40	$273.49
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $234.36 / $495.91 / $667.04	Professional	TC	$234.36	$495.91	$667.04
Molina Facility/Professional Professional Modifier Low / Median / High Price $65.45 / $296.35 / $712.29	Professional		$65.45	$296.35	$712.29
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $139.65 / $196.98 / $204.35	Facility	26	$139.65	$196.98	$204.35
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $323.43 / $323.43 / $347.03	Professional		$323.43	$323.43	$347.03
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $130.41 / $167.75 / $204.35	Professional	26	$130.41	$167.75	$204.35
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $292.66 / $407.00 / $495.80	Professional	TC	$292.66	$407.00	$495.80
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $135.90 / $135.90 / $139.38	Facility	26	$135.90	$135.90	$139.38
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $531.16 / $796.60 / $948.17	Professional		$531.16	$796.60	$948.17
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $156.16 / $232.50 / $276.85	Professional	26	$156.16	$232.50	$276.85
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $375.00 / $564.10 / $672.05	Professional	TC	$375.00	$564.10	$672.05
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $1,374.41 / $1,374.41 / $2,406.69	Facility	26	$1,374.41	$1,374.41	$2,406.69
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $469.85 / $715.83 / $938.62	Professional		$469.85	$715.83	$938.62
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $138.60 / $208.93 / $273.95	Professional	26	$138.60	$208.93	$273.95
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $331.25 / $506.90 / $664.67	Professional	TC	$331.25	$506.90	$664.67
United Facility/Professional Professional Modifier Low / Median / High Price $405.49 / $437.99 / $942.69	Professional		$405.49	$437.99	$942.69
United Facility/Professional Professional Modifier 26 Low / Median / High Price $121.84 / $135.01 / $277.17	Professional	26	$121.84	$135.01	$277.17
United Facility/Professional Professional Modifier TC Low / Median / High Price $277.94 / $296.38 / $632.30	Professional	TC	$277.94	$296.38	$632.30
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $401.38 / $401.38 / $401.38	Professional		$401.38	$401.38	$401.38
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $110.34 / $110.34 / $110.34	Professional	26	$110.34	$110.34	$110.34
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $291.04 / $291.04 / $291.04	Professional	TC	$291.04	$291.04	$291.04