Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $78.75 / $155.44 / $253.90	Facility	26	$78.75	$155.44	$253.90
Aetna Facility/Professional Professional Modifier Low / Median / High Price $365.30 / $475.00 / $848.41	Professional		$365.30	$475.00	$848.41
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $78.75 / $124.79 / $222.17	Professional	26	$78.75	$124.79	$222.17
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $249.00 / $335.00 / $626.24	Professional	TC	$249.00	$335.00	$626.24
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $207.90 / $207.90 / $207.90	Professional		$207.90	$207.90	$207.90
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $111.41 / $111.41 / $111.41	Professional	26	$111.41	$111.41	$111.41
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $653.60 / $653.60 / $653.60	Facility	26	$653.60	$653.60	$653.60
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $380.77 / $657.82 / $2,872.81	Professional		$380.77	$657.82	$2,872.81
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $96.10 / $172.85 / $575.03	Professional	26	$96.10	$172.85	$575.03
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $292.91 / $519.27 / $2,498.98	Professional	TC	$292.91	$519.27	$2,498.98
Cigna Facility/Professional Professional Modifier Low / Median / High Price $292.80 / $578.40 / $960.75	Professional		$292.80	$578.40	$960.75
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $69.53 / $126.16 / $219.82	Professional	26	$69.53	$126.16	$219.82
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $222.96 / $446.12 / $742.84	Professional	TC	$222.96	$446.12	$742.84
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $76.95 / $157.38 / $698.97	Facility	26	$76.95	$157.38	$698.97
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $336.97 / $684.23 / $1,121.88	Professional		$336.97	$684.23	$1,121.88
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $68.20 / $147.16 / $191.22	Professional	26	$68.20	$147.16	$191.22
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $272.49 / $544.12 / $952.32	Professional	TC	$272.49	$544.12	$952.32
Molina Facility/Professional Professional Modifier Low / Median / High Price $52.95 / $226.44 / $553.93	Professional		$52.95	$226.44	$553.93
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $111.30 / $136.53 / $140.69	Facility	26	$111.30	$136.53	$140.69
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $178.16 / $178.16 / $178.16	Professional		$178.16	$178.16	$178.16
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $84.42 / $133.03 / $156.75	Professional	26	$84.42	$133.03	$156.75
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $297.61 / $448.73 / $647.28	Professional	TC	$297.61	$448.73	$647.28
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $94.22 / $94.22 / $94.60	Facility	26	$94.22	$94.22	$94.60
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $428.38 / $641.73 / $790.95	Professional		$428.38	$641.73	$790.95
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $106.85 / $162.47 / $194.02	Professional	26	$106.85	$162.47	$194.02
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $321.16 / $480.94 / $611.16	Professional	TC	$321.16	$480.94	$611.16
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $446.45 / $446.45 / $782.93	Facility	26	$446.45	$446.45	$782.93
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $389.00 / $563.98 / $836.60	Professional		$389.00	$563.98	$836.60
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $96.10 / $143.24 / $192.22	Professional	26	$96.10	$143.24	$192.22
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $292.91 / $423.70 / $624.11	Professional	TC	$292.91	$423.70	$624.11
United Facility/Professional Professional Modifier Low / Median / High Price $266.27 / $433.48 / $854.99	Professional		$266.27	$433.48	$854.99
United Facility/Professional Professional Modifier 26 Low / Median / High Price $64.06 / $79.18 / $207.54	Professional	26	$64.06	$79.18	$207.54
United Facility/Professional Professional Modifier TC Low / Median / High Price $201.85 / $369.41 / $650.27	Professional	TC	$201.85	$369.41	$650.27
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $304.86 / $304.86 / $304.86	Professional		$304.86	$304.86	$304.86
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $72.38 / $72.38 / $72.38	Professional	26	$72.38	$72.38	$72.38
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $232.47 / $232.47 / $232.47	Professional	TC	$232.47	$232.47	$232.47