Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $96.00 / $188.69 / $308.48	Facility	26	$96.00	$188.69	$308.48
Aetna Facility/Professional Professional Modifier Low / Median / High Price $400.00 / $475.00 / $1,061.18	Professional		$400.00	$475.00	$1,061.18
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $86.72 / $140.00 / $380.94	Professional	26	$86.72	$140.00	$380.94
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $282.87 / $359.77 / $790.43	Professional	TC	$282.87	$359.77	$790.43
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $631.91 / $631.91 / $631.91	Professional		$631.91	$631.91	$631.91
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $135.68 / $135.68 / $135.68	Professional	26	$135.68	$135.68	$135.68
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $793.04 / $793.04 / $793.04	Facility	26	$793.04	$793.04	$793.04
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $486.95 / $866.52 / $3,032.66	Professional		$486.95	$866.52	$3,032.66
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $116.89 / $201.07 / $854.80	Professional	26	$116.89	$201.07	$854.80
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $376.60 / $669.16 / $2,562.41	Professional	TC	$376.60	$669.16	$2,562.41
Cigna Facility/Professional Professional Modifier Low / Median / High Price $370.96 / $725.17 / $1,198.19	Professional		$370.96	$725.17	$1,198.19
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $84.20 / $153.97 / $266.67	Professional	26	$84.20	$153.97	$266.67
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $285.45 / $565.44 / $922.71	Professional	TC	$285.45	$565.44	$922.71
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $99.05 / $179.57 / $233.51	Facility	26	$99.05	$179.57	$233.51
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $433.07 / $865.24 / $1,407.61	Professional		$433.07	$865.24	$1,407.61
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $93.89 / $188.70 / $233.24	Professional	26	$93.89	$188.70	$233.24
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $353.71 / $678.05 / $1,149.67	Professional	TC	$353.71	$678.05	$1,149.67
Molina Facility/Professional Professional Modifier Low / Median / High Price $73.20 / $318.25 / $770.64	Professional		$73.20	$318.25	$770.64
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $138.05 / $166.34 / $170.85	Facility	26	$138.05	$166.34	$170.85
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $117.97 / $153.60 / $180.34	Professional	26	$117.97	$153.60	$180.34
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $396.26 / $556.16 / $738.84	Professional	TC	$396.26	$556.16	$738.84
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $114.61 / $114.61 / $114.71	Facility	26	$114.61	$114.61	$114.71
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $538.17 / $811.02 / $980.56	Professional		$538.17	$811.02	$980.56
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $130.94 / $194.27 / $236.81	Professional	26	$130.94	$194.27	$236.81
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $407.25 / $613.38 / $755.09	Professional	TC	$407.25	$613.38	$755.09
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $486.95 / $712.76 / $1,041.09	Professional		$486.95	$712.76	$1,041.09
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $116.89 / $173.69 / $234.52	Professional	26	$116.89	$173.69	$234.52
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $370.06 / $539.07 / $799.64	Professional	TC	$370.06	$539.07	$799.64
United Facility/Professional Professional Modifier Low / Median / High Price $331.61 / $514.41 / $1,059.95	Professional		$331.61	$514.41	$1,059.95
United Facility/Professional Professional Modifier 26 Low / Median / High Price $77.92 / $96.26 / $247.42	Professional	26	$77.92	$96.26	$247.42
United Facility/Professional Professional Modifier TC Low / Median / High Price $253.69 / $424.36 / $814.59	Professional	TC	$253.69	$424.36	$814.59
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $387.97 / $387.97 / $387.97	Professional		$387.97	$387.97	$387.97
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $88.13 / $88.13 / $88.13	Professional	26	$88.13	$88.13	$88.13
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $299.83 / $299.83 / $299.83	Professional	TC	$299.83	$299.83	$299.83