Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $59.08 / $100.48 / $128.97	Facility	26	$59.08	$100.48	$128.97
Aetna Facility/Professional Professional Modifier Low / Median / High Price $206.63 / $304.58 / $623.03	Professional		$206.63	$304.58	$623.03
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $44.14 / $59.08 / $122.73	Professional	26	$44.14	$59.08	$122.73
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $162.49 / $250.24 / $498.98	Professional	TC	$162.49	$250.24	$498.98
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $24.82 / $24.82 / $77.95	Professional	26	$24.82	$24.82	$77.95
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $102.00 / $202.83 / $202.83	Facility	26	$102.00	$202.83	$202.83
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $376.11 / $678.99 / $2,382.60	Professional		$376.11	$678.99	$2,382.60
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $62.37 / $111.59 / $588.72	Professional	26	$62.37	$111.59	$588.72
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $303.44 / $541.41 / $2,003.55	Professional	TC	$303.44	$541.41	$2,003.55
Cigna Facility/Professional Professional Modifier Low / Median / High Price $326.44 / $535.97 / $905.07	Professional		$326.44	$535.97	$905.07
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $49.79 / $85.63 / $144.71	Professional	26	$49.79	$85.63	$144.71
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $270.86 / $449.16 / $769.10	Professional	TC	$270.86	$449.16	$769.10
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $43.71 / $97.04 / $158.37	Facility	26	$43.71	$97.04	$158.37
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $327.17 / $580.90 / $821.48	Professional		$327.17	$580.90	$821.48
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $43.71 / $93.46 / $117.98	Professional	26	$43.71	$93.46	$117.98
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $276.27 / $498.21 / $697.14	Professional	TC	$276.27	$498.21	$697.14
Molina Facility/Professional Professional Modifier Low / Median / High Price $46.22 / $288.58 / $624.07	Professional		$46.22	$288.58	$624.07
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $67.62 / $88.45 / $91.79	Facility	26	$67.62	$88.45	$91.79
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $55.07 / $80.40 / $101.25	Professional	26	$55.07	$80.40	$101.25
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $303.44 / $445.55 / $555.03	Professional	TC	$303.44	$445.55	$555.03
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $61.16 / $61.16 / $62.15	Facility	26	$61.16	$61.16	$62.15
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $417.04 / $627.37 / $771.40	Professional		$417.04	$627.37	$771.40
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $69.08 / $103.67 / $127.47	Professional	26	$69.08	$103.67	$127.47
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $347.96 / $523.70 / $643.92	Professional	TC	$347.96	$523.70	$643.92
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $385.75 / $385.75 / $446.45	Facility	26	$385.75	$385.75	$446.45
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $373.76 / $535.64 / $717.05	Professional		$373.76	$535.64	$717.05
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $62.37 / $88.72 / $120.43	Professional	26	$62.37	$88.72	$120.43
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $311.39 / $446.92 / $598.13	Professional	TC	$311.39	$446.92	$598.13
United Facility/Professional Professional Modifier Low / Median / High Price $308.00 / $462.00 / $773.47	Professional		$308.00	$462.00	$773.47
United Facility/Professional Professional Modifier 26 Low / Median / High Price $54.00 / $76.95 / $133.41	Professional	26	$54.00	$76.95	$133.41
United Facility/Professional Professional Modifier TC Low / Median / High Price $259.69 / $399.92 / $651.72	Professional	TC	$259.69	$399.92	$651.72
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $297.08 / $297.08 / $297.08	Professional		$297.08	$297.08	$297.08
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $47.25 / $47.25 / $47.25	Professional	26	$47.25	$47.25	$47.25
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $249.84 / $249.84 / $249.84	Professional	TC	$249.84	$249.84	$249.84