Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $48.86 / $65.91 / $108.78	Facility	26	$48.86	$65.91	$108.78
Aetna Facility/Professional Professional Modifier Low / Median / High Price $183.96 / $271.66 / $546.99	Professional		$183.96	$271.66	$546.99
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $21.46 / $40.46 / $91.61	Professional	26	$21.46	$40.46	$91.61
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $155.47 / $209.43 / $443.20	Professional	TC	$155.47	$209.43	$443.20
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $21.26 / $39.85 / $71.76	Professional	26	$21.26	$39.85	$71.76
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $87.53 / $169.56 / $169.56	Facility	26	$87.53	$169.56	$169.56
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $273.04 / $500.21 / $1,722.45	Professional		$273.04	$500.21	$1,722.45
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $48.94 / $85.22 / $391.31	Professional	26	$48.94	$85.22	$391.31
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $226.73 / $393.77 / $1,417.87	Professional	TC	$226.73	$393.77	$1,417.87
Cigna Facility/Professional Professional Modifier Low / Median / High Price $249.32 / $394.06 / $649.14	Professional		$249.32	$394.06	$649.14
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $35.06 / $64.87 / $119.55	Professional	26	$35.06	$64.87	$119.55
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $203.12 / $335.47 / $539.29	Professional	TC	$203.12	$335.47	$539.29
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $27.32 / $56.53 / $133.66	Facility	26	$27.32	$56.53	$133.66
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $225.68 / $436.45 / $604.16	Professional		$225.68	$436.45	$604.16
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $27.72 / $58.04 / $100.37	Professional	26	$27.72	$58.04	$100.37
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $205.53 / $361.12 / $536.25	Professional	TC	$205.53	$361.12	$536.25
Molina Facility/Professional Professional Modifier Low / Median / High Price $41.53 / $232.19 / $486.37	Professional		$41.53	$232.19	$486.37
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $43.55 / $73.13 / $76.38	Facility	26	$43.55	$73.13	$76.38
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $32.65 / $52.74 / $80.37	Professional	26	$32.65	$52.74	$80.37
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $218.16 / $318.25 / $393.00	Professional	TC	$218.16	$318.25	$393.00
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $51.18 / $51.18 / $51.19	Facility	26	$51.18	$51.18	$51.19
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $302.60 / $452.81 / $556.76	Professional		$302.60	$452.81	$556.76
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $57.53 / $85.38 / $104.98	Professional	26	$57.53	$85.38	$104.98
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $244.86 / $367.43 / $451.78	Professional	TC	$244.86	$367.43	$451.78
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $446.45 / $446.45 / $782.93	Facility	26	$446.45	$446.45	$782.93
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $273.04 / $388.65 / $525.99	Professional		$273.04	$388.65	$525.99
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $52.21 / $73.63 / $99.18	Professional	26	$52.21	$73.63	$99.18
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $220.84 / $315.92 / $426.81	Professional	TC	$220.84	$315.92	$426.81
United Facility/Professional Professional Modifier Low / Median / High Price $230.73 / $346.15 / $568.88	Professional		$230.73	$346.15	$568.88
United Facility/Professional Professional Modifier 26 Low / Median / High Price $33.65 / $66.12 / $112.85	Professional	26	$33.65	$66.12	$112.85
United Facility/Professional Professional Modifier TC Low / Median / High Price $186.14 / $310.80 / $477.87	Professional	TC	$186.14	$310.80	$477.87
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $226.94 / $226.94 / $226.94	Professional		$226.94	$226.94	$226.94
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $38.79 / $38.79 / $38.79	Professional	26	$38.79	$38.79	$38.79
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $188.16 / $188.16 / $188.16	Professional	TC	$188.16	$188.16	$188.16