Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $129.97 / $176.33 / $281.16	Facility	26	$129.97	$176.33	$281.16
Aetna Facility/Professional Professional Modifier Low / Median / High Price $242.28 / $345.72 / $587.41	Professional		$242.28	$345.72	$587.41
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $90.56 / $105.12 / $177.90	Professional	26	$90.56	$105.12	$177.90
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $148.33 / $215.75 / $377.96	Professional	TC	$148.33	$215.75	$377.96
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $281.49 / $281.49 / $281.49	Professional		$281.49	$281.49	$281.49
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $136.63 / $451.11 / $451.11	Facility	26	$136.63	$451.11	$451.11
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $310.35 / $600.88 / $2,526.44	Professional		$310.35	$600.88	$2,526.44
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $120.23 / $214.38 / $830.25	Professional	26	$120.23	$214.38	$830.25
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $205.02 / $392.18 / $1,696.20	Professional	TC	$205.02	$392.18	$1,696.20
Cigna Facility/Professional Professional Modifier Low / Median / High Price $286.63 / $505.73 / $900.57	Professional		$286.63	$505.73	$900.57
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $103.36 / $180.13 / $300.27	Professional	26	$103.36	$180.13	$300.27
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $182.70 / $330.39 / $599.79	Professional	TC	$182.70	$330.39	$599.79
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $84.78 / $144.02 / $245.76	Facility	26	$84.78	$144.02	$245.76
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $234.08 / $401.69 / $753.02	Professional		$234.08	$401.69	$753.02
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $84.84 / $136.87 / $242.30	Professional	26	$84.84	$136.87	$242.30
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $147.06 / $257.56 / $541.94	Professional	TC	$147.06	$257.56	$541.94
Molina Facility/Professional Professional Modifier Low / Median / High Price $61.65 / $272.06 / $674.58	Professional		$61.65	$272.06	$674.58
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $146.51 / $196.98 / $200.33	Facility	26	$146.51	$196.98	$200.33
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $114.35 / $164.45 / $212.29	Professional	26	$114.35	$164.45	$212.29
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $198.54 / $345.73 / $534.09	Professional	TC	$198.54	$345.73	$534.09
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $134.99 / $134.99 / $136.63	Facility	26	$134.99	$134.99	$136.63
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $402.16 / $615.10 / $798.25	Professional		$402.16	$615.10	$798.25
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $140.66 / $222.25 / $271.22	Professional	26	$140.66	$222.25	$271.22
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $265.52 / $387.26 / $527.03	Professional	TC	$265.52	$387.26	$527.03
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $356.66 / $539.88 / $751.39	Professional		$356.66	$539.88	$751.39
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $137.68 / $194.50 / $260.75	Professional	26	$137.68	$194.50	$260.75
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $218.99 / $347.60 / $490.30	Professional	TC	$218.99	$347.60	$490.30
United Facility/Professional Professional Modifier Low / Median / High Price $289.60 / $506.80 / $826.92	Professional		$289.60	$506.80	$826.92
United Facility/Professional Professional Modifier 26 Low / Median / High Price $123.48 / $177.43 / $286.74	Professional	26	$123.48	$177.43	$286.74
United Facility/Professional Professional Modifier TC Low / Median / High Price $178.35 / $301.64 / $498.75	Professional	TC	$178.35	$301.64	$498.75
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $240.46 / $290.05 / $331.08	Professional		$240.46	$290.05	$331.08
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $82.27 / $97.60 / $105.43	Professional	26	$82.27	$97.60	$105.43
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $158.19 / $192.45 / $225.65	Professional	TC	$158.19	$192.45	$225.65