Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $65.06 / $128.13 / $210.27	Facility	26	$65.06	$128.13	$210.27
Aetna Facility/Professional Professional Modifier Low / Median / High Price $207.18 / $315.56 / $520.83	Professional		$207.18	$315.56	$520.83
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $52.78 / $65.12 / $155.79	Professional	26	$52.78	$65.12	$155.79
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $137.68 / $244.97 / $440.02	Professional	TC	$137.68	$244.97	$440.02
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $128.12 / $128.12 / $128.12	Professional		$128.12	$128.12	$128.12
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $31.66 / $92.14 / $92.14	Professional	26	$31.66	$92.14	$92.14
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $540.32 / $540.32 / $540.32	Facility	26	$540.32	$540.32	$540.32
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $242.55 / $419.40 / $1,882.38	Professional		$242.55	$419.40	$1,882.38
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $79.45 / $142.76 / $474.38	Professional	26	$79.45	$142.76	$474.38
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $164.50 / $296.27 / $1,906.00	Professional	TC	$164.50	$296.27	$1,906.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $189.24 / $397.40 / $609.55	Professional		$189.24	$397.40	$609.55
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $57.38 / $105.02 / $181.76	Professional	26	$57.38	$105.02	$181.76
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $129.66 / $281.76 / $458.79	Professional	TC	$129.66	$281.76	$458.79
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $64.06 / $130.37 / $1,102.78	Facility	26	$64.06	$130.37	$1,102.78
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $244.90 / $457.73 / $791.74	Professional		$244.90	$457.73	$791.74
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $56.73 / $122.53 / $158.63	Professional	26	$56.73	$122.53	$158.63
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $179.19 / $334.12 / $611.55	Professional	TC	$179.19	$334.12	$611.55
Molina Facility/Professional Professional Modifier Low / Median / High Price $30.92 / $156.16 / $375.54	Professional		$30.92	$156.16	$375.54
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $93.99 / $112.96 / $116.58	Facility	26	$93.99	$112.96	$116.58
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $226.71 / $226.71 / $226.71	Professional		$226.71	$226.71	$226.71
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $69.95 / $103.11 / $123.54	Professional	26	$69.95	$103.11	$123.54
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $200.60 / $284.18 / $388.43	Professional	TC	$200.60	$284.18	$388.43
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $77.92 / $77.92 / $78.15	Facility	26	$77.92	$77.92	$78.15
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $270.64 / $409.45 / $499.82	Professional		$270.64	$409.45	$499.82
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $88.36 / $134.22 / $160.28	Professional	26	$88.36	$134.22	$160.28
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $181.97 / $274.80 / $339.77	Professional	TC	$181.97	$274.80	$339.77
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $714.15 / $714.15 / $1,538.06	Facility	26	$714.15	$714.15	$1,538.06
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $242.55 / $359.84 / $533.78	Professional		$242.55	$359.84	$533.78
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $79.45 / $118.33 / $160.03	Professional	26	$79.45	$118.33	$160.03
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $163.09 / $241.51 / $358.25	Professional	TC	$163.09	$241.51	$358.25
United Facility/Professional Professional Modifier Low / Median / High Price $169.02 / $289.13 / $536.71	Professional		$169.02	$289.13	$536.71
United Facility/Professional Professional Modifier 26 Low / Median / High Price $53.07 / $68.30 / $165.47	Professional	26	$53.07	$68.30	$165.47
United Facility/Professional Professional Modifier TC Low / Median / High Price $115.95 / $197.89 / $376.80	Professional	TC	$115.95	$197.89	$376.80
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $195.42 / $195.42 / $195.42	Professional		$195.42	$195.42	$195.42
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $59.90 / $59.90 / $59.90	Professional	26	$59.90	$59.90	$59.90
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $135.51 / $135.51 / $135.51	Professional	TC	$135.51	$135.51	$135.51