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 $269.83 / $343.39 / $706.57	Professional		$269.83	$343.39	$706.57
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $52.46 / $65.06 / $141.86	Professional	26	$52.46	$65.06	$141.86
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $192.00 / $290.93 / $522.47	Professional	TC	$192.00	$290.93	$522.47
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $198.25 / $198.25 / $198.25	Professional		$198.25	$198.25	$198.25
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $31.66 / $110.82 / $110.82	Professional	26	$31.66	$110.82	$110.82
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $537.20 / $537.20 / $537.20	Facility	26	$537.20	$537.20	$537.20
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $355.55 / $627.74 / $2,195.67	Professional		$355.55	$627.74	$2,195.67
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $79.45 / $140.72 / $471.45	Professional	26	$79.45	$140.72	$471.45
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $291.06 / $515.42 / $1,890.23	Professional	TC	$291.06	$515.42	$1,890.23
Cigna Facility/Professional Professional Modifier Low / Median / High Price $262.58 / $501.36 / $881.90	Professional		$262.58	$501.36	$881.90
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $57.28 / $105.02 / $180.66	Professional	26	$57.28	$105.02	$180.66
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $200.37 / $423.45 / $695.35	Professional	TC	$200.37	$423.45	$695.35
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $64.06 / $130.37 / $539.79	Facility	26	$64.06	$130.37	$539.79
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $262.52 / $567.85 / $931.02	Professional		$262.52	$567.85	$931.02
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $56.73 / $122.53 / $157.83	Professional	26	$56.73	$122.53	$157.83
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $233.12 / $454.53 / $772.06	Professional	TC	$233.12	$454.53	$772.06
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 $93.50 / $112.96 / $116.58	Facility	26	$93.50	$112.96	$116.58
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $140.29 / $140.29 / $197.03	Professional		$140.29	$140.29	$197.03
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $79.34 / $105.89 / $131.91	Professional	26	$79.34	$105.89	$131.91
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $255.36 / $383.54 / $592.91	Professional	TC	$255.36	$383.54	$592.91
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $77.69 / $77.69 / $77.92	Facility	26	$77.69	$77.69	$77.92
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $408.79 / $612.60 / $740.66	Professional		$408.79	$612.60	$740.66
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $88.36 / $133.69 / $160.06	Professional	26	$88.36	$133.69	$160.06
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $320.13 / $478.74 / $578.82	Professional	TC	$320.13	$478.74	$578.82
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 $370.52 / $538.38 / $723.35	Professional		$370.52	$538.38	$723.35
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $79.45 / $117.64 / $160.03	Professional	26	$79.45	$117.64	$160.03
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $291.06 / $421.03 / $570.54	Professional	TC	$291.06	$421.03	$570.54
United Facility/Professional Professional Modifier Low / Median / High Price $234.98 / $364.46 / $753.36	Professional		$234.98	$364.46	$753.36
United Facility/Professional Professional Modifier 26 Low / Median / High Price $52.96 / $66.45 / $165.47	Professional	26	$52.96	$66.45	$165.47
United Facility/Professional Professional Modifier TC Low / Median / High Price $181.91 / $294.92 / $586.03	Professional	TC	$181.91	$294.92	$586.03
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $276.70 / $276.70 / $276.70	Professional		$276.70	$276.70	$276.70
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 $216.81 / $216.81 / $216.81	Professional	TC	$216.81	$216.81	$216.81