Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $60.03 / $94.26 / $155.31	Facility	26	$60.03	$94.26	$155.31
Aetna Facility/Professional Professional Modifier Low / Median / High Price $186.26 / $297.81 / $519.15	Professional		$186.26	$297.81	$519.15
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $55.00 / $78.56 / $161.81	Professional	26	$55.00	$78.56	$161.81
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $121.66 / $231.15 / $414.48	Professional	TC	$121.66	$231.15	$414.48
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $254.12 / $254.12 / $254.12	Professional		$254.12	$254.12	$254.12
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $42.12 / $85.64 / $93.42	Professional	26	$42.12	$85.64	$93.42
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $498.88 / $498.88 / $498.88	Facility	26	$498.88	$498.88	$498.88
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $218.06 / $392.04 / $1,708.01	Professional		$218.06	$392.04	$1,708.01
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $73.00 / $132.80 / $438.75	Professional	26	$73.00	$132.80	$438.75
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $145.07 / $261.86 / $2,023.00	Professional	TC	$145.07	$261.86	$2,023.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $166.35 / $335.12 / $565.01	Professional		$166.35	$335.12	$565.01
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $53.15 / $98.97 / $173.77	Professional	26	$53.15	$98.97	$173.77
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $110.70 / $227.00 / $404.73	Professional	TC	$110.70	$227.00	$404.73
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $59.13 / $122.44 / $539.79	Facility	26	$59.13	$122.44	$539.79
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $202.43 / $384.97 / $749.02	Professional		$202.43	$384.97	$749.02
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $57.04 / $119.28 / $159.47	Professional	26	$57.04	$119.28	$159.47
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $134.53 / $264.14 / $599.21	Professional	TC	$134.53	$264.14	$599.21
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 $86.90 / $104.95 / $113.28	Facility	26	$86.90	$104.95	$113.28
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $67.62 / $96.60 / $122.10	Professional	26	$67.62	$96.60	$122.10
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $131.04 / $232.44 / $370.44	Professional	TC	$131.04	$232.44	$370.44
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $71.56 / $71.56 / $72.20	Facility	26	$71.56	$71.56	$72.20
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $243.32 / $368.50 / $449.25	Professional		$243.32	$368.50	$449.25
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $82.19 / $124.01 / $148.09	Professional	26	$82.19	$124.01	$148.09
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $160.84 / $244.09 / $302.33	Professional	TC	$160.84	$244.09	$302.33
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 $218.06 / $323.86 / $444.48	Professional		$218.06	$323.86	$444.48
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $73.00 / $109.34 / $148.27	Professional	26	$73.00	$109.34	$148.27
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $145.07 / $214.52 / $295.69	Professional	TC	$145.07	$214.52	$295.69
United Facility/Professional Professional Modifier Low / Median / High Price $144.18 / $281.19 / $462.95	Professional		$144.18	$281.19	$462.95
United Facility/Professional Professional Modifier 26 Low / Median / High Price $49.08 / $69.65 / $155.84	Professional	26	$49.08	$69.65	$155.84
United Facility/Professional Professional Modifier TC Low / Median / High Price $95.10 / $195.79 / $328.85	Professional	TC	$95.10	$195.79	$328.85
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $175.41 / $175.41 / $175.41	Professional		$175.41	$175.41	$175.41
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 $119.73 / $119.73 / $119.73	Professional	TC	$119.73	$119.73	$119.73