Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $297.27 / $402.51 / $631.32	Professional		$297.27	$402.51	$631.32
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $142.62 / $166.75 / $416.38	Professional	26	$142.62	$166.75	$416.38
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $154.63 / $209.01 / $590.00	Professional	TC	$154.63	$209.01	$590.00
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $462.73 / $462.73 / $462.73	Professional	26	$462.73	$462.73	$462.73
Asuris Northwest Health Facility/Professional Facility Modifier Low / Median / High Price $845.83 / $2,185.65 / $2,185.65	Facility		$845.83	$2,185.65	$2,185.65
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $276.06 / $846.88 / $846.88	Facility	26	$276.06	$846.88	$846.88
Asuris Northwest Health Facility/Professional Facility Modifier TC Low / Median / High Price $438.43 / $1,452.72 / $1,452.72	Facility	TC	$438.43	$1,452.72	$1,452.72
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $417.09 / $839.20 / $5,718.36	Professional		$417.09	$839.20	$5,718.36
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $237.01 / $421.74 / $1,412.85	Professional	26	$237.01	$421.74	$1,412.85
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $241.63 / $461.48 / $2,229.25	Professional	TC	$241.63	$461.48	$2,229.25
Cigna Facility/Professional Professional Modifier Low / Median / High Price $326.16 / $326.16 / $326.16	Professional		$326.16	$326.16	$326.16
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $153.56 / $153.56 / $153.56	Professional	26	$153.56	$153.56	$153.56
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $172.60 / $172.60 / $172.60	Professional	TC	$172.60	$172.60	$172.60
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $414.78 / $934.67 / $1,572.10	Facility		$414.78	$934.67	$1,572.10
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $170.50 / $363.14 / $927.23	Facility	26	$170.50	$363.14	$927.23
Kaiser Permanente Facility/Professional Facility Modifier TC Low / Median / High Price $294.95 / $620.94 / $1,148.66	Facility	TC	$294.95	$620.94	$1,148.66
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $616.90 / $934.67 / $1,199.78	Professional		$616.90	$934.67	$1,199.78
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $220.68 / $363.14 / $480.20	Professional	26	$220.68	$363.14	$480.20
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $353.89 / $575.11 / $789.12	Professional	TC	$353.89	$575.11	$789.12
Molina Facility/Professional Professional Modifier Low / Median / High Price $59.76 / $361.92 / $807.24	Professional		$59.76	$361.92	$807.24
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $598.95 / $725.35 / $1,152.15	Facility		$598.95	$725.35	$1,152.15
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $282.70 / $343.11 / $347.73	Facility	26	$282.70	$343.11	$347.73
Pacific Source Facility/Professional Facility Modifier TC Low / Median / High Price $301.50 / $382.24 / $595.35	Facility	TC	$301.50	$382.24	$595.35
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $207.03 / $262.45 / $408.63	Professional	26	$207.03	$262.45	$408.63
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $257.83 / $523.80 / $742.71	Professional	TC	$257.83	$523.80	$742.71
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $507.70 / $833.98 / $984.52	Professional		$507.70	$833.98	$984.52
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $239.99 / $401.87 / $473.89	Professional	26	$239.99	$401.87	$473.89
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $263.32 / $430.85 / $538.95	Professional	TC	$263.32	$430.85	$538.95
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $478.63 / $697.41 / $1,029.99	Professional		$478.63	$697.41	$1,029.99
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $237.01 / $322.70 / $423.32	Professional	26	$237.01	$322.70	$423.32
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $241.63 / $352.21 / $590.24	Professional	TC	$241.63	$352.21	$590.24
United Facility/Professional Professional Modifier Low / Median / High Price $208.74 / $320.52 / $709.79	Professional		$208.74	$320.52	$709.79
United Facility/Professional Professional Modifier 26 Low / Median / High Price $104.92 / $111.30 / $372.71	Professional	26	$104.92	$111.30	$372.71
United Facility/Professional Professional Modifier TC Low / Median / High Price $97.44 / $162.40 / $331.33	Professional	TC	$97.44	$162.40	$331.33