Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $73.56 / $97.56 / $155.18	Facility	26	$73.56	$97.56	$155.18
Aetna Facility/Professional Professional Modifier Low / Median / High Price $328.32 / $429.76 / $1,069.90	Professional		$328.32	$429.76	$1,069.90
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $50.40 / $65.86 / $154.40	Professional	26	$50.40	$65.86	$154.40
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $281.79 / $373.62 / $746.10	Professional	TC	$281.79	$373.62	$746.10
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $421.58 / $611.97 / $1,212.52	Professional		$421.58	$611.97	$1,212.52
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $54.48 / $100.60 / $150.22	Professional	26	$54.48	$100.60	$150.22
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 $481.89 / $912.76 / $3,959.70	Professional		$481.89	$912.76	$3,959.70
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $69.34 / $120.62 / $465.00	Professional	26	$69.34	$120.62	$465.00
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $426.14 / $829.02 / $3,494.70	Professional	TC	$426.14	$829.02	$3,494.70
Cigna Facility/Professional Professional Modifier Low / Median / High Price $364.64 / $743.85 / $1,405.23	Professional		$364.64	$743.85	$1,405.23
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 $321.95 / $644.82 / $1,237.28	Professional	TC	$321.95	$644.82	$1,237.28
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 $256.26 / $514.37 / $1,109.95	Professional		$256.26	$514.37	$1,109.95
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $46.48 / $75.15 / $133.99	Professional	26	$46.48	$75.15	$133.99
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $199.23 / $444.34 / $981.41	Professional	TC	$199.23	$444.34	$981.41
Molina Facility/Professional Professional Modifier Low / Median / High Price $74.11 / $399.15 / $1,086.80	Professional		$74.11	$399.15	$1,086.80
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 $66.33 / $91.20 / $124.29	Professional	26	$66.33	$91.20	$124.29
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $375.06 / $518.70 / $802.66	Professional	TC	$375.06	$518.70	$802.66
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $75.65 / $75.65 / $76.31	Facility	26	$75.65	$75.65	$76.31
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $640.80 / $992.99 / $1,238.19	Professional		$640.80	$992.99	$1,238.19
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 $561.13 / $870.95 / $1,086.71	Professional	TC	$561.13	$870.95	$1,086.71
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 $614.91 / $874.01 / $1,172.54	Professional		$614.91	$874.01	$1,172.54
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $77.15 / $108.63 / $147.11	Professional	26	$77.15	$108.63	$147.11
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $537.77 / $767.08 / $1,023.61	Professional	TC	$537.77	$767.08	$1,023.61
United Facility/Professional Professional Modifier Low / Median / High Price $403.59 / $733.19 / $1,260.64	Professional		$403.59	$733.19	$1,260.64
United Facility/Professional Professional Modifier 26 Low / Median / High Price $64.34 / $99.80 / $165.75	Professional	26	$64.34	$99.80	$165.75
United Facility/Professional Professional Modifier TC Low / Median / High Price $349.14 / $647.39 / $1,103.90	Professional	TC	$349.14	$647.39	$1,103.90
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $373.52 / $453.31 / $526.67	Professional		$373.52	$453.31	$526.67
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 $327.69 / $398.93 / $467.83	Professional	TC	$327.69	$398.93	$467.83