Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $241.11 / $321.54 / $504.53	Facility	26	$241.11	$321.54	$504.53
Aetna Facility/Professional Professional Modifier Low / Median / High Price $259.14 / $333.71 / $709.42	Professional		$259.14	$333.71	$709.42
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $161.72 / $197.00 / $420.27	Professional	26	$161.72	$197.00	$420.27
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $93.53 / $128.54 / $243.24	Professional	TC	$93.53	$128.54	$243.24
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $280.83 / $463.39 / $579.11	Professional		$280.83	$463.39	$579.11
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $167.67 / $320.25 / $359.07	Professional	26	$167.67	$320.25	$359.07
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $249.07 / $829.58 / $829.58	Facility	26	$249.07	$829.58	$829.58
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $314.31 / $584.99 / $2,415.83	Professional		$314.31	$584.99	$2,415.83
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $212.26 / $376.22 / $1,513.88	Professional	26	$212.26	$376.22	$1,513.88
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $124.09 / $213.83 / $901.95	Professional	TC	$124.09	$213.83	$901.95
Cigna Facility/Professional Professional Modifier Low / Median / High Price $251.49 / $491.49 / $867.56	Professional		$251.49	$491.49	$867.56
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $195.99 / $328.51 / $548.53	Professional	26	$195.99	$328.51	$548.53
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $114.23 / $196.28 / $319.02	Professional	TC	$114.23	$196.28	$319.02
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $168.33 / $282.08 / $479.78	Facility	26	$168.33	$282.08	$479.78
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $264.04 / $425.35 / $743.08	Professional		$264.04	$425.35	$743.08
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $159.88 / $261.62 / $449.94	Professional	26	$159.88	$261.62	$449.94
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $101.37 / $160.71 / $288.08	Professional	TC	$101.37	$160.71	$288.08
Molina Facility/Professional Professional Modifier Low / Median / High Price $58.61 / $278.03 / $669.83	Professional		$58.61	$278.03	$669.83
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $262.14 / $361.13 / $365.15	Facility	26	$262.14	$361.13	$365.15
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $216.68 / $313.88 / $388.08	Professional	26	$216.68	$313.88	$388.08
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $129.36 / $184.80 / $229.51	Professional	TC	$129.36	$184.80	$229.51
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $247.34 / $247.34 / $249.07	Facility	26	$247.34	$247.34	$249.07
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $403.03 / $636.79 / $786.41	Professional		$403.03	$636.79	$786.41
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $257.64 / $407.08 / $495.42	Professional	26	$257.64	$407.08	$495.42
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $145.40 / $233.60 / $289.63	Professional	TC	$145.40	$233.60	$289.63
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $946.29 / $946.29 / $1,497.68	Facility	26	$946.29	$946.29	$1,497.68
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $398.24 / $555.51 / $756.22	Professional		$398.24	$555.51	$756.22
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $252.25 / $354.51 / $481.85	Professional	26	$252.25	$354.51	$481.85
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $145.99 / $202.33 / $277.54	Professional	TC	$145.99	$202.33	$277.54
United Facility/Professional Professional Modifier Low / Median / High Price $361.04 / $531.48 / $856.11	Professional		$361.04	$531.48	$856.11
United Facility/Professional Professional Modifier 26 Low / Median / High Price $225.18 / $299.20 / $532.66	Professional	26	$225.18	$299.20	$532.66
United Facility/Professional Professional Modifier TC Low / Median / High Price $126.47 / $192.44 / $311.44	Professional	TC	$126.47	$192.44	$311.44
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $234.66 / $280.83 / $313.02	Professional		$234.66	$280.83	$313.02
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $151.29 / $179.40 / $194.09	Professional	26	$151.29	$179.40	$194.09
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $83.38 / $101.44 / $118.94	Professional	TC	$83.38	$101.44	$118.94