Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $79.18 / $124.31 / $228.28	Facility	26	$79.18	$124.31	$228.28
Aetna Facility/Professional Professional Modifier Low / Median / High Price $253.26 / $475.00 / $669.75	Professional		$253.26	$475.00	$669.75
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $79.18 / $140.00 / $256.05	Professional	26	$79.18	$140.00	$256.05
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $164.53 / $335.00 / $499.00	Professional	TC	$164.53	$335.00	$499.00
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $270.72 / $362.57 / $406.52	Professional		$270.72	$362.57	$406.52
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $55.45 / $117.07 / $187.00	Professional	26	$55.45	$117.07	$187.00
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $656.72 / $656.72 / $656.72	Facility	26	$656.72	$656.72	$656.72
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $276.27 / $471.22 / $3,174.82	Professional		$276.27	$471.22	$3,174.82
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $96.56 / $168.42 / $609.25	Professional	26	$96.56	$168.42	$609.25
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $179.72 / $325.56 / $2,772.01	Professional	TC	$179.72	$325.56	$2,772.01
Cigna Facility/Professional Professional Modifier Low / Median / High Price $209.71 / $423.71 / $846.21	Professional		$209.71	$423.71	$846.21
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $70.13 / $128.22 / $224.33	Professional	26	$70.13	$128.22	$224.33
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $138.88 / $294.89 / $631.27	Professional	TC	$138.88	$294.89	$631.27
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $78.05 / $159.18 / $698.97	Facility	26	$78.05	$159.18	$698.97
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $272.45 / $501.82 / $1,158.74	Professional		$272.45	$501.82	$1,158.74
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $70.37 / $153.69 / $194.91	Professional	26	$70.37	$153.69	$194.91
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $182.91 / $344.05 / $964.99	Professional	TC	$182.91	$344.05	$964.99
Molina Facility/Professional Professional Modifier Low / Median / High Price $37.16 / $177.58 / $385.40	Professional		$37.16	$177.58	$385.40
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $114.40 / $137.85 / $142.04	Facility	26	$114.40	$137.85	$142.04
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $233.66 / $233.66 / $233.66	Professional		$233.66	$233.66	$233.66
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $96.67 / $138.12 / $169.11	Professional	26	$96.67	$138.12	$169.11
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $192.89 / $283.41 / $686.17	Professional	TC	$192.89	$283.41	$686.17
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $94.68 / $94.68 / $95.06	Facility	26	$94.68	$94.68	$95.06
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $306.20 / $462.20 / $578.45	Professional		$306.20	$462.20	$578.45
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $108.26 / $163.26 / $194.96	Professional	26	$108.26	$163.26	$194.96
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $197.95 / $298.42 / $380.97	Professional	TC	$197.95	$298.42	$380.97
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $446.45 / $446.45 / $782.93	Facility	26	$446.45	$446.45	$782.93
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $276.27 / $406.20 / $586.77	Professional		$276.27	$406.20	$586.77
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $96.56 / $143.94 / $194.98	Professional	26	$96.56	$143.94	$194.98
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $179.72 / $262.27 / $391.79	Professional	TC	$179.72	$262.27	$391.79
United Facility/Professional Professional Modifier Low / Median / High Price $187.43 / $299.39 / $626.08	Professional		$187.43	$299.39	$626.08
United Facility/Professional Professional Modifier 26 Low / Median / High Price $64.73 / $84.54 / $213.04	Professional	26	$64.73	$84.54	$213.04
United Facility/Professional Professional Modifier TC Low / Median / High Price $122.70 / $252.63 / $478.45	Professional	TC	$122.70	$252.63	$478.45
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $219.74 / $219.74 / $219.74	Professional		$219.74	$219.74	$219.74
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $73.17 / $73.17 / $73.17	Professional	26	$73.17	$73.17	$73.17
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $146.56 / $146.56 / $146.56	Professional	TC	$146.56	$146.56	$146.56