Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $79.91 / $140.69 / $233.58	Facility	26	$79.91	$140.69	$233.58
Aetna Facility/Professional Professional Modifier Low / Median / High Price $300.45 / $475.00 / $892.51	Professional		$300.45	$475.00	$892.51
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $78.36 / $119.21 / $226.41	Professional	26	$78.36	$119.21	$226.41
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $219.86 / $335.00 / $616.97	Professional	TC	$219.86	$335.00	$616.97
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $121.85 / $121.85 / $136.62	Professional	26	$121.85	$121.85	$136.62
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $666.24 / $666.24 / $666.24	Facility	26	$666.24	$666.24	$666.24
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $356.20 / $640.13 / $3,076.60	Professional		$356.20	$640.13	$3,076.60
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $97.94 / $168.18 / $867.00	Professional	26	$97.94	$168.18	$867.00
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $268.32 / $497.09 / $2,747.24	Professional	TC	$268.32	$497.09	$2,747.24
Cigna Facility/Professional Professional Modifier Low / Median / High Price $276.64 / $621.80 / $1,026.26	Professional		$276.64	$621.80	$1,026.26
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $61.05 / $122.64 / $224.14	Professional	26	$61.05	$122.64	$224.14
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $203.41 / $468.60 / $814.25	Professional	TC	$203.41	$468.60	$814.25
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $69.75 / $140.76 / $1,102.78	Facility	26	$69.75	$140.76	$1,102.78
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $410.76 / $723.21 / $1,358.11	Professional		$410.76	$723.21	$1,358.11
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $69.75 / $132.71 / $188.42	Professional	26	$69.75	$132.71	$188.42
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $330.16 / $574.52 / $1,220.65	Professional	TC	$330.16	$574.52	$1,220.65
Molina Facility/Professional Professional Modifier Low / Median / High Price $47.87 / $248.09 / $578.88	Professional		$47.87	$248.09	$578.88
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $98.04 / $135.51 / $142.71	Facility	26	$98.04	$135.51	$142.71
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $268.35 / $268.35 / $268.35	Professional		$268.35	$268.35	$268.35
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $68.80 / $107.54 / $143.56	Professional	26	$68.80	$107.54	$143.56
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $339.95 / $596.40 / $749.73	Professional	TC	$339.95	$596.40	$749.73
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $96.04 / $96.04 / $96.43	Facility	26	$96.04	$96.04	$96.43
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $395.90 / $604.95 / $739.17	Professional		$395.90	$604.95	$739.17
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $103.46 / $164.83 / $197.77	Professional	26	$103.46	$164.83	$197.77
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $286.62 / $437.96 / $542.88	Professional	TC	$286.62	$437.96	$542.88
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $714.15 / $714.15 / $851.78	Facility	26	$714.15	$714.15	$851.78
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $356.20 / $525.23 / $779.11	Professional		$356.20	$525.23	$779.11
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $97.94 / $144.54 / $196.82	Professional	26	$97.94	$144.54	$196.82
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $258.26 / $379.22 / $585.26	Professional	TC	$258.26	$379.22	$585.26
United Facility/Professional Professional Modifier Low / Median / High Price $237.43 / $463.78 / $809.46	Professional		$237.43	$463.78	$809.46
United Facility/Professional Professional Modifier 26 Low / Median / High Price $60.49 / $85.20 / $222.92	Professional	26	$60.49	$85.20	$222.92
United Facility/Professional Professional Modifier TC Low / Median / High Price $172.09 / $370.46 / $587.13	Professional	TC	$172.09	$370.46	$587.13
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $286.20 / $286.20 / $286.20	Professional		$286.20	$286.20	$286.20
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $73.84 / $73.84 / $73.84	Professional	26	$73.84	$73.84	$73.84
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $212.35 / $212.35 / $212.35	Professional	TC	$212.35	$212.35	$212.35