Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $62.00 / $105.78 / $200.51	Facility	26	$62.00	$105.78	$200.51
Aetna Facility/Professional Professional Modifier Low / Median / High Price $227.97 / $328.23 / $613.64	Professional		$227.97	$328.23	$613.64
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $50.07 / $66.23 / $153.90	Professional	26	$50.07	$66.23	$153.90
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $171.77 / $251.41 / $419.56	Professional	TC	$171.77	$251.41	$419.56
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $158.47 / $379.16 / $379.16	Professional		$158.47	$379.16	$379.16
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $43.15 / $87.80 / $99.50	Professional	26	$43.15	$87.80	$99.50
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 $290.60 / $517.70 / $1,779.53	Professional		$290.60	$517.70	$1,779.53
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $74.84 / $136.12 / $452.55	Professional	26	$74.84	$136.12	$452.55
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $215.75 / $392.07 / $1,330.47	Professional	TC	$215.75	$392.07	$1,330.47
Cigna Facility/Professional Professional Modifier Low / Median / High Price $217.67 / $416.83 / $704.25	Professional		$217.67	$416.83	$704.25
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 $162.69 / $316.81 / $538.71	Professional	TC	$162.69	$316.81	$538.71
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $61.12 / $124.22 / $1,094.31	Facility	26	$61.12	$124.22	$1,094.31
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $239.32 / $485.12 / $765.48	Professional		$239.32	$485.12	$765.48
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 $188.17 / $360.80 / $611.61	Professional	TC	$188.17	$360.80	$611.61
Molina Facility/Professional Professional Modifier Low / Median / High Price $36.60 / $201.84 / $457.79	Professional		$36.60	$201.84	$457.79
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $89.59 / $107.62 / $111.22	Facility	26	$89.59	$107.62	$111.22
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $69.72 / $99.18 / $121.18	Professional	26	$69.72	$99.18	$121.18
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $217.14 / $309.54 / $414.12	Professional	TC	$217.14	$309.54	$414.12
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $73.39 / $73.39 / $74.48	Facility	26	$73.39	$73.39	$74.48
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $323.73 / $486.61 / $588.34	Professional		$323.73	$486.61	$588.34
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $84.25 / $127.94 / $152.78	Professional	26	$84.25	$127.94	$152.78
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $239.19 / $358.27 / $433.16	Professional	TC	$239.19	$358.27	$433.16
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $714.15 / $714.15 / $851.78	Facility	26	$714.15	$714.15	$851.78
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $290.60 / $427.66 / $579.41	Professional		$290.60	$427.66	$579.41
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $74.84 / $112.80 / $152.66	Professional	26	$74.84	$112.80	$152.66
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $215.75 / $314.86 / $426.97	Professional	TC	$215.75	$314.86	$426.97
United Facility/Professional Professional Modifier Low / Median / High Price $192.03 / $280.33 / $609.77	Professional		$192.03	$280.33	$609.77
United Facility/Professional Professional Modifier 26 Low / Median / High Price $50.31 / $65.11 / $159.76	Professional	26	$50.31	$65.11	$159.76
United Facility/Professional Professional Modifier TC Low / Median / High Price $141.72 / $212.52 / $450.01	Professional	TC	$141.72	$212.52	$450.01
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $232.46 / $232.46 / $232.46	Professional		$232.46	$232.46	$232.46
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 $175.37 / $175.37 / $175.37	Professional	TC	$175.37	$175.37	$175.37