Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $60.47 / $99.82 / $238.06	Facility	26	$60.47	$99.82	$238.06
Aetna Facility/Professional Professional Modifier Low / Median / High Price $220.70 / $354.98 / $581.38	Professional		$220.70	$354.98	$581.38
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $55.00 / $69.47 / $147.88	Professional	26	$55.00	$69.47	$147.88
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $156.11 / $272.87 / $490.54	Professional	TC	$156.11	$272.87	$490.54
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $143.24 / $143.24 / $143.24	Professional		$143.24	$143.24	$143.24
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $42.12 / $87.95 / $142.84	Professional	26	$42.12	$87.95	$142.84
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $502.08 / $502.08 / $502.08	Facility	26	$502.08	$502.08	$502.08
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $259.64 / $466.46 / $1,940.92	Professional		$259.64	$466.46	$1,940.92
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $73.00 / $134.51 / $556.79	Professional	26	$73.00	$134.51	$556.79
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $186.75 / $351.54 / $1,561.11	Professional	TC	$186.75	$351.54	$1,561.11
Cigna Facility/Professional Professional Modifier Low / Median / High Price $202.49 / $464.98 / $676.61	Professional		$202.49	$464.98	$676.61
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $54.68 / $108.52 / $174.95	Professional	26	$54.68	$108.52	$174.95
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $148.43 / $321.27 / $534.04	Professional	TC	$148.43	$321.27	$534.04
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $67.20 / $137.19 / $539.79	Facility	26	$67.20	$137.19	$539.79
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $274.10 / $523.94 / $851.90	Professional		$274.10	$523.94	$851.90
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $64.48 / $129.58 / $172.12	Professional	26	$64.48	$129.58	$172.12
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $220.99 / $396.10 / $693.87	Professional	TC	$220.99	$396.10	$693.87
Molina Facility/Professional Professional Modifier Low / Median / High Price $35.99 / $194.07 / $399.31	Professional		$35.99	$194.07	$399.31
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $87.39 / $104.95 / $131.99	Facility	26	$87.39	$104.95	$131.99
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $140.29 / $140.29 / $214.94	Professional		$140.29	$140.29	$214.94
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $78.80 / $110.40 / $136.01	Professional	26	$78.80	$110.40	$136.01
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $233.20 / $323.61 / $524.40	Professional	TC	$233.20	$323.61	$524.40
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $71.56 / $71.56 / $72.66	Facility	26	$71.56	$71.56	$72.66
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $289.70 / $437.79 / $534.91	Professional		$289.70	$437.79	$534.91
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $82.48 / $124.88 / $149.03	Professional	26	$82.48	$124.88	$149.03
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $207.23 / $312.60 / $382.62	Professional	TC	$207.23	$312.60	$382.62
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $346.39 / $346.39 / $851.78	Facility	26	$346.39	$346.39	$851.78
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $259.64 / $384.75 / $593.80	Professional		$259.64	$384.75	$593.80
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $73.00 / $110.03 / $158.60	Professional	26	$73.00	$110.03	$158.60
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $186.65 / $274.72 / $413.94	Professional	TC	$186.65	$274.72	$413.94
United Facility/Professional Professional Modifier Low / Median / High Price $192.95 / $308.20 / $612.67	Professional		$192.95	$308.20	$612.67
United Facility/Professional Professional Modifier 26 Low / Median / High Price $49.08 / $71.50 / $165.71	Professional	26	$49.08	$71.50	$165.71
United Facility/Professional Professional Modifier TC Low / Median / High Price $143.04 / $241.29 / $461.71	Professional	TC	$143.04	$241.29	$461.71
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $209.35 / $209.35 / $209.35	Professional		$209.35	$209.35	$209.35
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $55.68 / $55.68 / $55.68	Professional	26	$55.68	$55.68	$55.68
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $153.66 / $153.66 / $153.66	Professional	TC	$153.66	$153.66	$153.66