Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $111.26 / $148.44 / $239.43	Facility	26	$111.26	$148.44	$239.43
Aetna Facility/Professional Professional Modifier Low / Median / High Price $335.55 / $435.56 / $980.87	Professional		$335.55	$435.56	$980.87
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $75.47 / $94.51 / $227.06	Professional	26	$75.47	$94.51	$227.06
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $263.72 / $341.06 / $784.06	Professional	TC	$263.72	$341.06	$784.06
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $82.37 / $111.26 / $164.67	Professional	26	$82.37	$111.26	$164.67
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $115.16 / $379.97 / $379.97	Facility	26	$115.16	$379.97	$379.97
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $480.54 / $911.05 / $3,845.18	Professional		$480.54	$911.05	$3,845.18
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $104.00 / $181.15 / $774.69	Professional	26	$104.00	$181.15	$774.69
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $380.31 / $745.98 / $3,144.15	Professional	TC	$380.31	$745.98	$3,144.15
Cigna Facility/Professional Professional Modifier Low / Median / High Price $386.75 / $739.36 / $1,367.00	Professional		$386.75	$739.36	$1,367.00
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $85.97 / $151.80 / $253.56	Professional	26	$85.97	$151.80	$253.56
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $294.42 / $578.16 / $1,113.44	Professional	TC	$294.42	$578.16	$1,113.44
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $73.36 / $124.74 / $217.48	Facility	26	$73.36	$124.74	$217.48
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $316.93 / $568.79 / $1,073.26	Professional		$316.93	$568.79	$1,073.26
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $72.92 / $118.23 / $205.48	Professional	26	$72.92	$118.23	$205.48
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $227.37 / $434.92 / $889.50	Professional	TC	$227.37	$434.92	$889.50
Molina Facility/Professional Professional Modifier Low / Median / High Price $93.10 / $409.25 / $1,094.96	Professional		$93.10	$409.25	$1,094.96
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $128.38 / $165.97 / $171.12	Facility	26	$128.38	$165.97	$171.12
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $101.68 / $147.32 / $171.12	Professional	26	$101.68	$147.32	$171.12
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $363.81 / $527.36 / $757.84	Professional	TC	$363.81	$527.36	$757.84
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $114.61 / $114.61 / $115.16	Facility	26	$114.61	$114.61	$115.16
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $619.08 / $966.91 / $1,206.44	Professional		$619.08	$966.91	$1,206.44
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $118.54 / $187.08 / $228.59	Professional	26	$118.54	$187.08	$228.59
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $492.65 / $779.41 / $977.85	Professional	TC	$492.65	$779.41	$977.85
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $513.03 / $513.03 / $838.61	Facility	26	$513.03	$513.03	$838.61
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $587.66 / $847.53 / $1,134.88	Professional		$587.66	$847.53	$1,134.88
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $116.89 / $163.92 / $222.87	Professional	26	$116.89	$163.92	$222.87
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $470.78 / $678.96 / $919.85	Professional	TC	$470.78	$678.96	$919.85
United Facility/Professional Professional Modifier Low / Median / High Price $416.83 / $698.77 / $1,217.89	Professional		$416.83	$698.77	$1,217.89
United Facility/Professional Professional Modifier 26 Low / Median / High Price $98.32 / $150.27 / $250.11	Professional	26	$98.32	$150.27	$250.11
United Facility/Professional Professional Modifier TC Low / Median / High Price $317.10 / $559.90 / $980.38	Professional	TC	$317.10	$559.90	$980.38
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $366.89 / $444.57 / $513.94	Professional		$366.89	$444.57	$513.94
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $69.29 / $82.24 / $89.01	Professional	26	$69.29	$82.24	$89.01
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $297.60 / $362.34 / $424.93	Professional	TC	$297.60	$362.34	$424.93