Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $71.56 / $118.53 / $231.84	Facility	26	$71.56	$118.53	$231.84
Aetna Facility/Professional Professional Modifier Low / Median / High Price $307.52 / $475.00 / $720.48	Professional		$307.52	$475.00	$720.48
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $71.56 / $126.00 / $203.08	Professional	26	$71.56	$126.00	$203.08
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $203.29 / $335.00 / $517.40	Professional	TC	$203.29	$335.00	$517.40
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $179.09 / $179.09 / $179.09	Professional		$179.09	$179.09	$179.09
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $35.06 / $105.82 / $109.13	Professional	26	$35.06	$105.82	$109.13
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $596.96 / $596.96 / $596.96	Facility	26	$596.96	$596.96	$596.96
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $329.87 / $561.66 / $2,821.00	Professional		$329.87	$561.66	$2,821.00
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $87.78 / $150.72 / $625.77	Professional	26	$87.78	$150.72	$625.77
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $242.09 / $436.72 / $2,451.15	Professional	TC	$242.09	$436.72	$2,451.15
Cigna Facility/Professional Professional Modifier Low / Median / High Price $255.42 / $524.75 / $885.86	Professional		$255.42	$524.75	$885.86
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $63.14 / $115.68 / $200.79	Professional	26	$63.14	$115.68	$200.79
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $189.79 / $407.21 / $699.56	Professional	TC	$189.79	$407.21	$699.56
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $70.69 / $143.97 / $698.97	Facility	26	$70.69	$143.97	$698.97
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $328.48 / $608.39 / $1,214.07	Professional		$328.48	$608.39	$1,214.07
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $62.62 / $135.19 / $174.93	Professional	26	$62.62	$135.19	$174.93
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $247.00 / $463.69 / $1,045.88	Professional	TC	$247.00	$463.69	$1,045.88
Molina Facility/Professional Professional Modifier Low / Median / High Price $42.36 / $239.82 / $486.63	Professional		$42.36	$239.82	$486.63
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $103.88 / $124.74 / $128.63	Facility	26	$103.88	$124.74	$128.63
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $78.09 / $120.33 / $139.10	Professional	26	$78.09	$120.33	$139.10
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $284.24 / $396.27 / $672.03	Professional	TC	$284.24	$396.27	$672.03
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $86.07 / $86.07 / $86.37	Facility	26	$86.07	$86.07	$86.37
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $364.97 / $549.61 / $696.38	Professional		$364.97	$549.61	$696.38
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $97.60 / $147.56 / $177.15	Professional	26	$97.60	$147.56	$177.15
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $267.02 / $408.03 / $519.52	Professional	TC	$267.02	$408.03	$519.52
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 $329.87 / $483.02 / $706.33	Professional		$329.87	$483.02	$706.33
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $87.78 / $130.79 / $176.58	Professional	26	$87.78	$130.79	$176.58
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $242.09 / $352.23 / $529.75	Professional	TC	$242.09	$352.23	$529.75
United Facility/Professional Professional Modifier Low / Median / High Price $225.17 / $422.81 / $746.23	Professional		$225.17	$422.81	$746.23
United Facility/Professional Professional Modifier 26 Low / Median / High Price $58.29 / $76.79 / $185.07	Professional	26	$58.29	$76.79	$185.07
United Facility/Professional Professional Modifier TC Low / Median / High Price $166.88 / $343.58 / $608.62	Professional	TC	$166.88	$343.58	$608.62
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $262.43 / $262.43 / $262.43	Professional		$262.43	$262.43	$262.43
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $66.14 / $66.14 / $66.14	Professional	26	$66.14	$66.14	$66.14
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $196.29 / $196.29 / $196.29	Professional	TC	$196.29	$196.29	$196.29