Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $86.87 / $141.53 / $250.32	Facility	26	$86.87	$141.53	$250.32
Aetna Facility/Professional Professional Modifier Low / Median / High Price $270.37 / $371.00 / $654.73	Professional		$270.37	$371.00	$654.73
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $62.17 / $86.87 / $183.36	Professional	26	$62.17	$86.87	$183.36
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $178.14 / $285.00 / $526.09	Professional	TC	$178.14	$285.00	$526.09
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $175.43 / $175.43 / $750.00	Professional		$175.43	$175.43	$750.00
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $42.07 / $122.27 / $122.27	Professional	26	$42.07	$122.27	$122.27
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $714.16 / $714.16 / $714.16	Facility	26	$714.16	$714.16	$714.16
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $319.70 / $569.64 / $2,036.01	Professional		$319.70	$569.64	$2,036.01
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $105.34 / $182.86 / $626.85	Professional	26	$105.34	$182.86	$626.85
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $214.37 / $385.08 / $2,005.00	Professional	TC	$214.37	$385.08	$2,005.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $243.23 / $480.54 / $786.29	Professional		$243.23	$480.54	$786.29
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $71.09 / $135.63 / $240.17	Professional	26	$71.09	$135.63	$240.17
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $162.90 / $330.74 / $560.79	Professional	TC	$162.90	$330.74	$560.79
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $78.41 / $162.66 / $539.79	Facility	26	$78.41	$162.66	$539.79
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $262.52 / $534.16 / $956.86	Professional		$262.52	$534.16	$956.86
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $75.64 / $155.34 / $206.55	Professional	26	$75.64	$155.34	$206.55
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $198.19 / $386.44 / $728.44	Professional	TC	$198.19	$386.44	$728.44
Molina Facility/Professional Professional Modifier Low / Median / High Price $39.71 / $222.56 / $499.23	Professional		$39.71	$222.56	$499.23
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $117.99 / $145.99 / $154.77	Facility	26	$117.99	$145.99	$154.77
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $140.29 / $140.29 / $155.88	Professional		$140.29	$140.29	$155.88
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $92.86 / $122.96 / $154.21	Professional	26	$92.86	$122.96	$154.21
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $231.95 / $363.44 / $517.94	Professional	TC	$231.95	$363.44	$517.94
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $103.28 / $103.28 / $103.28	Facility	26	$103.28	$103.28	$103.28
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $355.70 / $535.42 / $647.36	Professional		$355.70	$535.42	$647.36
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $117.12 / $174.92 / $214.34	Professional	26	$117.12	$174.92	$214.34
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $238.16 / $357.48 / $439.73	Professional	TC	$238.16	$357.48	$439.73
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 $319.70 / $470.56 / $644.39	Professional		$319.70	$470.56	$644.39
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $105.34 / $156.38 / $212.45	Professional	26	$105.34	$156.38	$212.45
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $214.37 / $314.17 / $428.40	Professional	TC	$214.37	$314.17	$428.40
United Facility/Professional Professional Modifier Low / Median / High Price $211.36 / $344.28 / $700.00	Professional		$211.36	$344.28	$700.00
United Facility/Professional Professional Modifier 26 Low / Median / High Price $63.63 / $87.54 / $220.93	Professional	26	$63.63	$87.54	$220.93
United Facility/Professional Professional Modifier TC Low / Median / High Price $140.50 / $280.08 / $463.47	Professional	TC	$140.50	$280.08	$463.47
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $254.85 / $254.85 / $254.85	Professional		$254.85	$254.85	$254.85
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $79.47 / $79.47 / $79.47	Professional	26	$79.47	$79.47	$79.47
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $175.37 / $175.37 / $175.37	Professional	TC	$175.37	$175.37	$175.37