Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $181.59 / $249.00 / $942.61	Facility		$181.59	$249.00	$942.61
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $29.35 / $39.79 / $65.83	Facility	26	$29.35	$39.79	$65.83
Aetna Facility/Professional Professional Modifier Low / Median / High Price $108.66 / $142.87 / $316.52	Professional		$108.66	$142.87	$316.52
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.78 / $23.04 / $45.10	Professional	26	$11.78	$23.04	$45.10
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $95.35 / $117.15 / $271.72	Professional	TC	$95.35	$117.15	$271.72
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $152.62 / $152.62 / $409.37	Professional		$152.62	$152.62	$409.37
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $35.99 / $35.99 / $35.99	Professional	26	$35.99	$35.99	$35.99
Asuris Northwest Health Facility/Professional Facility Modifier Low / Median / High Price $70.20 / $245.42 / $601.01	Facility		$70.20	$245.42	$601.01
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $100.00 / $102.96 / $102.96	Facility	26	$100.00	$102.96	$102.96
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $168.48 / $332.45 / $1,197.25	Professional		$168.48	$332.45	$1,197.25
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $24.08 / $47.81 / $198.13	Professional	26	$24.08	$47.81	$198.13
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $157.26 / $284.30 / $1,126.14	Professional	TC	$157.26	$284.30	$1,126.14
Cigna Facility/Professional Facility Modifier Low / Median / High Price $234.44 / $234.44 / $442.89	Facility		$234.44	$234.44	$442.89
Cigna Facility/Professional Professional Modifier Low / Median / High Price $156.53 / $277.45 / $469.14	Professional		$156.53	$277.45	$469.14
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $15.97 / $35.06 / $67.81	Professional	26	$15.97	$35.06	$67.81
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $133.72 / $237.54 / $398.83	Professional	TC	$133.72	$237.54	$398.83
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $141.97 / $297.54 / $485.62	Facility		$141.97	$297.54	$485.62
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $15.48 / $29.20 / $65.45	Facility	26	$15.48	$29.20	$65.45
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $159.03 / $280.35 / $474.77	Professional		$159.03	$280.35	$474.77
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $16.20 / $28.78 / $52.80	Professional	26	$16.20	$28.78	$52.80
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $136.71 / $258.72 / $445.56	Professional	TC	$136.71	$258.72	$445.56
Molina Facility/Professional Professional Modifier Low / Median / High Price $30.87 / $147.45 / $334.93	Professional		$30.87	$147.45	$334.93
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $225.89 / $284.88 / $350.42	Facility		$225.89	$284.88	$350.42
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $24.15 / $43.78 / $46.90	Facility	26	$24.15	$43.78	$46.90
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $18.09 / $28.14 / $46.90	Professional	26	$18.09	$28.14	$46.90
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $163.28 / $255.27 / $337.56	Professional	TC	$163.28	$255.27	$337.56
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $207.45 / $334.04 / $413.35	Professional		$207.45	$334.04	$413.35
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $32.22 / $52.50 / $64.67	Professional	26	$32.22	$52.50	$64.67
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $174.99 / $281.52 / $348.68	Professional	TC	$174.99	$281.52	$348.68
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $202.73 / $202.73 / $311.56	Facility		$202.73	$202.73	$311.56
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $205.13 / $289.91 / $379.46	Professional		$205.13	$289.91	$379.46
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $32.34 / $45.36 / $58.88	Professional	26	$32.34	$45.36	$58.88
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $172.79 / $244.55 / $329.41	Professional	TC	$172.79	$244.55	$329.41
United Facility/Professional Professional Modifier Low / Median / High Price $157.08 / $252.97 / $418.04	Professional		$157.08	$252.97	$418.04
United Facility/Professional Professional Modifier 26 Low / Median / High Price $17.51 / $34.79 / $68.12	Professional	26	$17.51	$34.79	$68.12
United Facility/Professional Professional Modifier TC Low / Median / High Price $132.50 / $217.12 / $353.28	Professional	TC	$132.50	$217.12	$353.28
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $109.60 / $152.62 / $152.62	Professional		$109.60	$152.62	$152.62
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $18.78 / $23.14 / $23.14	Professional	26	$18.78	$23.14	$23.14
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $90.83 / $129.47 / $129.47	Professional	TC	$90.83	$129.47	$129.47