Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $63.89 / $105.54 / $187.43	Facility	26	$63.89	$105.54	$187.43
Aetna Facility/Professional Professional Modifier Low / Median / High Price $288.83 / $475.00 / $717.30	Professional		$288.83	$475.00	$717.30
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $63.90 / $140.00 / $207.92	Professional	26	$63.90	$140.00	$207.92
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $224.93 / $335.00 / $617.22	Professional	TC	$224.93	$335.00	$617.22
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $106.70 / $409.14 / $800.00	Professional		$106.70	$409.14	$800.00
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $90.50 / $90.50 / $150.99	Professional	26	$90.50	$90.50	$150.99
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $262.29 / $262.29 / $262.29	Professional	TC	$262.29	$262.29	$262.29
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $446.45 / $530.79 / $530.79	Facility	26	$446.45	$530.79	$530.79
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $311.85 / $560.11 / $2,968.23	Professional		$311.85	$560.11	$2,968.23
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $78.54 / $136.34 / $505.24	Professional	26	$78.54	$136.34	$505.24
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $242.42 / $451.57 / $2,638.88	Professional	TC	$242.42	$451.57	$2,638.88
Cigna Facility/Professional Professional Modifier Low / Median / High Price $242.70 / $563.33 / $931.29	Professional		$242.70	$563.33	$931.29
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $56.37 / $103.20 / $178.54	Professional	26	$56.37	$103.20	$178.54
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $183.91 / $430.78 / $772.89	Professional	TC	$183.91	$430.78	$772.89
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $62.96 / $128.86 / $698.97	Facility	26	$62.96	$128.86	$698.97
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $350.14 / $659.13 / $1,309.55	Professional		$350.14	$659.13	$1,309.55
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $55.80 / $120.41 / $155.97	Professional	26	$55.80	$120.41	$155.97
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $299.47 / $538.71 / $1,172.91	Professional	TC	$299.47	$538.71	$1,172.91
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 $92.34 / $110.96 / $115.24	Facility	26	$92.34	$110.96	$115.24
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $68.40 / $101.40 / $119.07	Professional	26	$68.40	$101.40	$119.07
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $302.80 / $482.80 / $888.00	Professional	TC	$302.80	$482.80	$888.00
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $76.78 / $76.78 / $77.01	Facility	26	$76.78	$76.78	$77.01
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $346.42 / $523.62 / $653.33	Professional		$346.42	$523.62	$653.33
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $87.33 / $131.86 / $159.94	Professional	26	$87.33	$131.86	$159.94
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $258.77 / $395.43 / $496.08	Professional	TC	$258.77	$395.43	$496.08
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 $311.85 / $460.18 / $710.22	Professional		$311.85	$460.18	$710.22
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $78.54 / $116.26 / $157.27	Professional	26	$78.54	$116.26	$157.27
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $233.31 / $343.92 / $530.79	Professional	TC	$233.31	$343.92	$530.79
United Facility/Professional Professional Modifier Low / Median / High Price $211.67 / $438.52 / $757.02	Professional		$211.67	$438.52	$757.02
United Facility/Professional Professional Modifier 26 Low / Median / High Price $52.15 / $64.42 / $165.59	Professional	26	$52.15	$64.42	$165.59
United Facility/Professional Professional Modifier TC Low / Median / High Price $159.52 / $353.95 / $576.54	Professional	TC	$159.52	$353.95	$576.54
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $251.06 / $251.06 / $251.06	Professional		$251.06	$251.06	$251.06
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $58.83 / $58.83 / $58.83	Professional	26	$58.83	$58.83	$58.83
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $192.22 / $192.22 / $192.22	Professional	TC	$192.22	$192.22	$192.22