Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $66.59 / $130.94 / $238.06	Facility	26	$66.59	$130.94	$238.06
Aetna Facility/Professional Professional Modifier Low / Median / High Price $240.00 / $354.55 / $645.13	Professional		$240.00	$354.55	$645.13
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $59.34 / $69.23 / $168.30	Professional	26	$59.34	$69.23	$168.30
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $168.52 / $285.00 / $417.78	Professional	TC	$168.52	$285.00	$417.78
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $155.84 / $164.08 / $420.86	Professional		$155.84	$164.08	$420.86
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $32.70 / $94.73 / $113.94	Professional	26	$32.70	$94.73	$113.94
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $553.04 / $553.04 / $553.04	Facility	26	$553.04	$553.04	$553.04
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $284.12 / $484.71 / $2,319.03	Professional		$284.12	$484.71	$2,319.03
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $81.77 / $143.26 / $543.21	Professional	26	$81.77	$143.26	$543.21
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $202.36 / $362.93 / $1,973.17	Professional	TC	$202.36	$362.93	$1,973.17
Cigna Facility/Professional Professional Modifier Low / Median / High Price $219.43 / $434.36 / $735.52	Professional		$219.43	$434.36	$735.52
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $60.08 / $116.21 / $192.76	Professional	26	$60.08	$116.21	$192.76
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $159.33 / $331.35 / $564.53	Professional	TC	$159.33	$331.35	$564.53
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $72.53 / $138.72 / $539.79	Facility	26	$72.53	$138.72	$539.79
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $262.52 / $513.51 / $930.10	Professional		$262.52	$513.51	$930.10
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $64.48 / $133.38 / $173.45	Professional	26	$64.48	$133.38	$173.45
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $201.16 / $379.01 / $768.79	Professional	TC	$201.16	$379.01	$768.79
Molina Facility/Professional Professional Modifier Low / Median / High Price $36.65 / $201.84 / $457.79	Professional		$36.65	$201.84	$457.79
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $96.25 / $116.06 / $131.99	Facility	26	$96.25	$116.06	$131.99
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $78.80 / $112.19 / $135.93	Professional	26	$78.80	$112.19	$135.93
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $232.76 / $333.98 / $527.82	Professional	TC	$232.76	$333.98	$527.82
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $79.98 / $79.98 / $80.18	Facility	26	$79.98	$79.98	$80.18
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $314.97 / $475.59 / $586.87	Professional		$314.97	$475.59	$586.87
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $90.73 / $137.36 / $166.60	Professional	26	$90.73	$137.36	$166.60
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $224.24 / $337.79 / $423.07	Professional	TC	$224.24	$337.79	$423.07
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 $284.13 / $417.97 / $612.52	Professional		$284.13	$417.97	$612.52
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $81.77 / $121.10 / $166.76	Professional	26	$81.77	$121.10	$166.76
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $202.36 / $296.87 / $431.34	Professional	TC	$202.36	$296.87	$431.34
United Facility/Professional Professional Modifier Low / Median / High Price $200.32 / $357.59 / $643.22	Professional		$200.32	$357.59	$643.22
United Facility/Professional Professional Modifier 26 Low / Median / High Price $59.81 / $73.89 / $178.55	Professional	26	$59.81	$73.89	$178.55
United Facility/Professional Professional Modifier TC Low / Median / High Price $140.51 / $288.56 / $452.65	Professional	TC	$140.51	$288.56	$452.65
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $227.49 / $227.49 / $227.49	Professional		$227.49	$227.49	$227.49
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $61.59 / $61.59 / $61.59	Professional	26	$61.59	$61.59	$61.59
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $165.90 / $165.90 / $165.90	Professional	TC	$165.90	$165.90	$165.90