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 $203.91 / $307.42 / $499.54	Professional		$203.91	$307.42	$499.54
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $50.07 / $66.23 / $164.82	Professional	26	$50.07	$66.23	$164.82
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $137.68 / $234.76 / $422.51	Professional	TC	$137.68	$234.76	$422.51
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $126.08 / $126.08 / $126.08	Professional		$126.08	$126.08	$126.08
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $42.57 / $87.80 / $146.47	Professional	26	$42.57	$87.80	$146.47
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 $239.32 / $429.94 / $1,638.03	Professional		$239.32	$429.94	$1,638.03
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $75.31 / $136.12 / $452.55	Professional	26	$75.31	$136.12	$452.55
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $167.65 / $309.93 / $1,335.34	Professional	TC	$167.65	$309.93	$1,335.34
Cigna Facility/Professional Professional Modifier Low / Median / High Price $186.36 / $389.67 / $601.73	Professional		$186.36	$389.67	$601.73
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 $130.41 / $280.01 / $456.50	Professional	TC	$130.41	$280.01	$456.50
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 $242.73 / $451.90 / $769.89	Professional		$242.73	$451.90	$769.89
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 $180.18 / $333.40 / $585.22	Professional	TC	$180.18	$333.40	$585.22
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 $89.59 / $107.62 / $111.22	Facility	26	$89.59	$107.62	$111.22
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $140.29 / $155.88 / $198.80	Professional		$140.29	$155.88	$198.80
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $66.40 / $96.28 / $115.44	Professional	26	$66.40	$96.28	$115.44
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $189.18 / $260.95 / $349.81	Professional	TC	$189.18	$260.95	$349.81
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 $267.02 / $403.94 / $488.38	Professional		$267.02	$403.94	$488.38
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $84.19 / $127.94 / $152.78	Professional	26	$84.19	$127.94	$152.78
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $182.49 / $275.58 / $341.64	Professional	TC	$182.49	$275.58	$341.64
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 $239.32 / $355.00 / $526.59	Professional		$239.32	$355.00	$526.59
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 $164.01 / $242.20 / $359.28	Professional	TC	$164.01	$242.20	$359.28
United Facility/Professional Professional Modifier Low / Median / High Price $167.19 / $267.45 / $530.88	Professional		$167.19	$267.45	$530.88
United Facility/Professional Professional Modifier 26 Low / Median / High Price $50.31 / $62.15 / $156.85	Professional	26	$50.31	$62.15	$156.85
United Facility/Professional Professional Modifier TC Low / Median / High Price $116.88 / $227.08 / $373.11	Professional	TC	$116.88	$227.08	$373.11
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $192.60 / $192.60 / $192.60	Professional		$192.60	$192.60	$192.60
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 $135.51 / $135.51 / $135.51	Professional	TC	$135.51	$135.51	$135.51