Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $68.12 / $106.96 / $200.53	Facility	26	$68.12	$106.96	$200.53
Aetna Facility/Professional Professional Modifier Low / Median / High Price $194.77 / $273.85 / $486.76	Professional		$194.77	$273.85	$486.76
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $55.15 / $77.28 / $176.88	Professional	26	$55.15	$77.28	$176.88
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $121.26 / $201.03 / $310.11	Professional	TC	$121.26	$201.03	$310.11
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $126.66 / $300.77 / $338.03	Professional		$126.66	$300.77	$338.03
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $73.83 / $104.59 / $160.96	Professional	26	$73.83	$104.59	$160.96
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $571.36 / $571.36 / $571.36	Facility	26	$571.36	$571.36	$571.36
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $227.30 / $409.64 / $1,670.68	Professional		$227.30	$409.64	$1,670.68
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $83.62 / $147.32 / $520.49	Professional	26	$83.62	$147.32	$520.49
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $144.88 / $272.73 / $1,318.41	Professional	TC	$144.88	$272.73	$1,318.41
Cigna Facility/Professional Professional Modifier Low / Median / High Price $179.08 / $392.73 / $586.90	Professional		$179.08	$392.73	$586.90
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $60.15 / $110.08 / $192.26	Professional	26	$60.15	$110.08	$192.26
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $116.34 / $261.52 / $418.72	Professional	TC	$116.34	$261.52	$418.72
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $74.62 / $137.94 / $319.91	Facility	26	$74.62	$137.94	$319.91
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $230.92 / $442.87 / $740.81	Professional		$230.92	$442.87	$740.81
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $67.01 / $131.94 / $167.21	Professional	26	$67.01	$131.94	$167.21
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $182.84 / $322.27 / $586.04	Professional	TC	$182.84	$322.27	$586.04
Molina Facility/Professional Professional Modifier Low / Median / High Price $29.46 / $149.27 / $312.59	Professional		$29.46	$149.27	$312.59
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $99.48 / $119.39 / $122.61	Facility	26	$99.48	$119.39	$122.61
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $86.94 / $86.94 / $86.94	Professional		$86.94	$86.94	$86.94
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $73.16 / $109.04 / $128.02	Professional	26	$73.16	$109.04	$128.02
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $181.55 / $271.94 / $430.36	Professional	TC	$181.55	$271.94	$430.36
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $81.99 / $81.99 / $82.72	Facility	26	$81.99	$81.99	$82.72
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $253.63 / $385.04 / $465.53	Professional		$253.63	$385.04	$465.53
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $92.45 / $140.50 / $169.65	Professional	26	$92.45	$140.50	$169.65
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $159.81 / $242.52 / $298.58	Professional	TC	$159.81	$242.52	$298.58
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $211.40 / $211.40 / $385.75	Facility	26	$211.40	$211.40	$385.75
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $227.30 / $338.39 / $514.44	Professional		$227.30	$338.39	$514.44
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $83.62 / $125.25 / $167.39	Professional	26	$83.62	$125.25	$167.39
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $143.68 / $213.14 / $330.00	Professional	TC	$143.68	$213.14	$330.00
United Facility/Professional Professional Modifier Low / Median / High Price $173.02 / $276.37 / $549.39	Professional		$173.02	$276.37	$549.39
United Facility/Professional Professional Modifier 26 Low / Median / High Price $55.52 / $73.22 / $172.89	Professional	26	$55.52	$73.22	$172.89
United Facility/Professional Professional Modifier TC Low / Median / High Price $117.50 / $204.98 / $356.07	Professional	TC	$117.50	$204.98	$356.07
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $182.72 / $182.72 / $182.72	Professional		$182.72	$182.72	$182.72
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $63.39 / $63.39 / $63.39	Professional	26	$63.39	$63.39	$63.39
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $119.33 / $119.33 / $119.33	Professional	TC	$119.33	$119.33	$119.33