Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $73.09 / $97.56 / $154.22	Facility	26	$73.09	$97.56	$154.22
Aetna Facility/Professional Professional Modifier Low / Median / High Price $296.76 / $390.51 / $919.92	Professional		$296.76	$390.51	$919.92
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $50.40 / $65.30 / $150.13	Professional	26	$50.40	$65.30	$150.13
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $239.26 / $316.08 / $662.85	Professional	TC	$239.26	$316.08	$662.85
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $346.98 / $622.61 / $1,010.30	Professional		$346.98	$622.61	$1,010.30
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $54.48 / $97.10 / $108.87	Professional	26	$54.48	$97.10	$108.87
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $76.31 / $251.32 / $251.32	Facility	26	$76.31	$251.32	$251.32
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $418.38 / $792.69 / $3,434.55	Professional		$418.38	$792.69	$3,434.55
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $68.94 / $119.74 / $465.00	Professional	26	$68.94	$119.74	$465.00
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $357.59 / $697.33 / $2,969.48	Professional	TC	$357.59	$697.33	$2,969.48
Cigna Facility/Professional Professional Modifier Low / Median / High Price $318.23 / $639.34 / $1,219.34	Professional		$318.23	$639.34	$1,219.34
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $57.44 / $99.03 / $167.95	Professional	26	$57.44	$99.03	$167.95
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $271.43 / $540.30 / $1,051.40	Professional	TC	$271.43	$540.30	$1,051.40
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $47.25 / $80.94 / $142.34	Facility	26	$47.25	$80.94	$142.34
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $238.25 / $464.50 / $955.40	Professional		$238.25	$464.50	$955.40
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $46.72 / $75.18 / $133.01	Professional	26	$46.72	$75.18	$133.01
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $181.22 / $376.70 / $822.53	Professional	TC	$181.22	$376.70	$822.53
Molina Facility/Professional Professional Modifier Low / Median / High Price $72.19 / $331.11 / $911.00	Professional		$72.19	$331.11	$911.00
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $80.36 / $109.76 / $111.89	Facility	26	$80.36	$109.76	$111.89
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $65.53 / $93.38 / $119.72	Professional	26	$65.53	$93.38	$119.72
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $321.08 / $458.98 / $670.56	Professional	TC	$321.08	$458.98	$670.56
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $75.20 / $75.20 / $76.31	Facility	26	$75.20	$75.20	$76.31
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $551.98 / $861.50 / $1,074.91	Professional		$551.98	$861.50	$1,074.91
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $78.56 / $123.47 / $151.49	Professional	26	$78.56	$123.47	$151.49
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $471.19 / $739.38 / $923.43	Professional	TC	$471.19	$739.38	$923.43
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 $523.91 / $743.90 / $1,011.15	Professional		$523.91	$743.90	$1,011.15
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $76.69 / $108.63 / $146.22	Professional	26	$76.69	$108.63	$146.22
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $447.22 / $635.01 / $868.65	Professional	TC	$447.22	$635.01	$868.65
United Facility/Professional Professional Modifier Low / Median / High Price $355.01 / $640.38 / $1,104.53	Professional		$355.01	$640.38	$1,104.53
United Facility/Professional Professional Modifier 26 Low / Median / High Price $65.41 / $99.22 / $162.37	Professional	26	$65.41	$99.22	$162.37
United Facility/Professional Professional Modifier TC Low / Median / High Price $285.77 / $523.75 / $930.06	Professional	TC	$285.77	$523.75	$930.06
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $320.79 / $389.13 / $451.42	Professional		$320.79	$389.13	$451.42
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $45.83 / $54.38 / $58.85	Professional	26	$45.83	$54.38	$58.85
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $274.95 / $334.75 / $392.57	Professional	TC	$274.95	$334.75	$392.57