Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $97.21 / $119.71 / $283.08	Facility	26	$97.21	$119.71	$283.08
Aetna Facility/Professional Professional Modifier Low / Median / High Price $280.33 / $438.87 / $829.40	Professional		$280.33	$438.87	$829.40
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $82.98 / $97.62 / $280.83	Professional	26	$82.98	$97.62	$280.83
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $217.28 / $318.48 / $561.36	Professional	TC	$217.28	$318.48	$561.36
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $224.53 / $502.79 / $803.91	Professional		$224.53	$502.79	$803.91
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $92.54 / $138.19 / $166.15	Professional	26	$92.54	$138.19	$166.15
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $346.39 / $804.96 / $804.96	Facility	26	$346.39	$804.96	$804.96
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $395.76 / $694.14 / $3,183.14	Professional		$395.76	$694.14	$3,183.14
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $118.27 / $210.46 / $1,009.00	Professional	26	$118.27	$210.46	$1,009.00
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $286.44 / $513.55 / $2,699.58	Professional	TC	$286.44	$513.55	$2,699.58
Cigna Facility/Professional Professional Modifier Low / Median / High Price $298.07 / $592.60 / $1,003.60	Professional		$298.07	$592.60	$1,003.60
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $85.74 / $158.13 / $270.77	Professional	26	$85.74	$158.13	$270.77
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $208.00 / $442.18 / $733.18	Professional	TC	$208.00	$442.18	$733.18
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $95.36 / $194.80 / $539.79	Facility	26	$95.36	$194.80	$539.79
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $314.81 / $669.80 / $1,203.19	Professional		$314.81	$669.80	$1,203.19
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $85.42 / $187.77 / $236.67	Professional	26	$85.42	$187.77	$236.67
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $252.94 / $485.17 / $925.98	Professional	TC	$252.94	$485.17	$925.98
Molina Facility/Professional Professional Modifier Low / Median / High Price $48.08 / $248.09 / $578.88	Professional		$48.08	$248.09	$578.88
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $140.25 / $169.19 / $177.45	Facility	26	$140.25	$169.19	$177.45
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $117.30 / $117.30 / $117.30	Professional		$117.30	$117.30	$117.30
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $109.75 / $161.07 / $189.65	Professional	26	$109.75	$161.07	$189.65
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $268.13 / $413.00 / $720.69	Professional	TC	$268.13	$413.00	$720.69
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $115.97 / $115.97 / $116.54	Facility	26	$115.97	$115.97	$116.54
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $451.06 / $681.89 / $827.42	Professional		$451.06	$681.89	$827.42
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $132.47 / $200.53 / $239.62	Professional	26	$132.47	$200.53	$239.62
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $318.58 / $481.10 / $587.80	Professional	TC	$318.58	$481.10	$587.80
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 $404.71 / $599.27 / $817.16	Professional		$404.71	$599.27	$817.16
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $118.27 / $176.46 / $238.20	Professional	26	$118.27	$176.46	$238.20
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $286.44 / $422.81 / $583.85	Professional	TC	$286.44	$422.81	$583.85
United Facility/Professional Professional Modifier Low / Median / High Price $261.66 / $441.15 / $842.97	Professional		$261.66	$441.15	$842.97
United Facility/Professional Professional Modifier 26 Low / Median / High Price $79.14 / $102.68 / $248.45	Professional	26	$79.14	$102.68	$248.45
United Facility/Professional Professional Modifier TC Low / Median / High Price $182.52 / $300.02 / $605.99	Professional	TC	$182.52	$300.02	$605.99
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $306.89 / $306.89 / $306.89	Professional		$306.89	$306.89	$306.89
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $89.81 / $89.81 / $89.81	Professional	26	$89.81	$89.81	$89.81
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $217.08 / $217.08 / $217.08	Professional	TC	$217.08	$217.08	$217.08