Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $62.00 / $101.79 / $180.77	Facility	26	$62.00	$101.79	$180.77
Aetna Facility/Professional Professional Modifier Low / Median / High Price $267.55 / $314.75 / $624.60	Professional		$267.55	$314.75	$624.60
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $50.07 / $66.23 / $155.04	Professional	26	$50.07	$66.23	$155.04
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $203.21 / $255.50 / $449.39	Professional	TC	$203.21	$255.50	$449.39
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $179.65 / $436.95 / $436.95	Professional		$179.65	$436.95	$436.95
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $57.09 / $87.80 / $105.62	Professional	26	$57.09	$87.80	$105.62
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $514.88 / $514.88 / $514.88	Facility	26	$514.88	$514.88	$514.88
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $335.87 / $588.42 / $2,012.40	Professional		$335.87	$588.42	$2,012.40
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $75.31 / $135.12 / $452.55	Professional	26	$75.31	$135.12	$452.55
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $260.57 / $460.65 / $1,559.85	Professional	TC	$260.57	$460.65	$1,559.85
Cigna Facility/Professional Professional Modifier Low / Median / High Price $224.49 / $458.16 / $768.73	Professional		$224.49	$458.16	$768.73
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $54.48 / $100.18 / $173.19	Professional	26	$54.48	$100.18	$173.19
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $178.68 / $354.71 / $603.92	Professional	TC	$178.68	$354.71	$603.92
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $61.12 / $124.22 / $539.79	Facility	26	$61.12	$124.22	$539.79
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $255.44 / $492.85 / $792.18	Professional		$255.44	$492.85	$792.18
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $54.25 / $116.89 / $150.91	Professional	26	$54.25	$116.89	$150.91
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $202.86 / $382.54 / $627.17	Professional	TC	$202.86	$382.54	$627.17
Molina Facility/Professional Professional Modifier Low / Median / High Price $43.01 / $251.57 / $541.02	Professional		$43.01	$251.57	$541.02
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $87.98 / $107.62 / $111.22	Facility	26	$87.98	$107.62	$111.22
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $155.88 / $155.88 / $214.94	Professional		$155.88	$155.88	$214.94
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $66.40 / $105.66 / $123.11	Professional	26	$66.40	$105.66	$123.11
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $204.06 / $325.68 / $456.96	Professional	TC	$204.06	$325.68	$456.96
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $73.84 / $73.84 / $74.48	Facility	26	$73.84	$73.84	$74.48
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $370.53 / $554.41 / $671.16	Professional		$370.53	$554.41	$671.16
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $84.19 / $126.16 / $152.78	Professional	26	$84.19	$126.16	$152.78
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $285.10 / $426.77 / $515.98	Professional	TC	$285.10	$426.77	$515.98
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 $335.87 / $487.86 / $655.71	Professional		$335.87	$487.86	$655.71
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $75.31 / $112.80 / $152.66	Professional	26	$75.31	$112.80	$152.66
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $260.57 / $375.06 / $508.61	Professional	TC	$260.57	$375.06	$508.61
United Facility/Professional Professional Modifier Low / Median / High Price $208.90 / $297.82 / $673.00	Professional		$208.90	$297.82	$673.00
United Facility/Professional Professional Modifier 26 Low / Median / High Price $50.31 / $67.23 / $162.08	Professional	26	$50.31	$67.23	$162.08
United Facility/Professional Professional Modifier TC Low / Median / High Price $158.59 / $225.63 / $509.23	Professional	TC	$158.59	$225.63	$509.23
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $264.82 / $264.82 / $264.82	Professional		$264.82	$264.82	$264.82
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $57.09 / $57.09 / $57.09	Professional	26	$57.09	$57.09	$57.09
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $207.73 / $207.73 / $207.73	Professional	TC	$207.73	$207.73	$207.73