Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $67.76 / $105.78 / $220.18	Facility	26	$67.76	$105.78	$220.18
Aetna Facility/Professional Professional Modifier Low / Median / High Price $264.77 / $356.20 / $703.02	Professional		$264.77	$356.20	$703.02
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $54.86 / $76.50 / $175.49	Professional	26	$54.86	$76.50	$175.49
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $209.38 / $285.00 / $472.29	Professional	TC	$209.38	$285.00	$472.29
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $182.96 / $437.94 / $443.54	Professional		$182.96	$437.94	$443.54
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $33.24 / $103.37 / $160.05	Professional	26	$33.24	$103.37	$160.05
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $565.04 / $565.04 / $565.04	Facility	26	$565.04	$565.04	$565.04
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $342.80 / $601.47 / $2,057.40	Professional		$342.80	$601.47	$2,057.40
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $83.16 / $147.81 / $497.63	Professional	26	$83.16	$147.81	$497.63
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $259.64 / $446.19 / $2,104.00	Professional	TC	$259.64	$446.19	$2,104.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $242.46 / $466.30 / $783.80	Professional		$242.46	$466.30	$783.80
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $60.02 / $109.26 / $190.10	Professional	26	$60.02	$109.26	$190.10
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $177.32 / $371.97 / $603.53	Professional	TC	$177.32	$371.97	$603.53
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $74.20 / $136.44 / $539.79	Facility	26	$74.20	$136.44	$539.79
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $259.77 / $503.82 / $844.36	Professional		$259.77	$503.82	$844.36
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $66.64 / $131.22 / $165.49	Professional	26	$66.64	$131.22	$165.49
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $202.43 / $381.83 / $663.00	Professional	TC	$202.43	$381.83	$663.00
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 $98.38 / $118.06 / $121.94	Facility	26	$98.38	$118.06	$121.94
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $140.29 / $145.07 / $155.88	Professional		$140.29	$145.07	$155.88
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $72.76 / $112.94 / $142.69	Professional	26	$72.76	$112.94	$142.69
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $214.76 / $331.35 / $421.56	Professional	TC	$214.76	$331.35	$421.56
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $81.54 / $81.54 / $81.80	Facility	26	$81.54	$81.54	$81.80
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $377.35 / $564.64 / $683.54	Professional		$377.35	$564.64	$683.54
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $92.47 / $139.71 / $167.78	Professional	26	$92.47	$139.71	$167.78
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $283.56 / $424.41 / $513.13	Professional	TC	$283.56	$424.41	$513.13
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 $342.80 / $496.86 / $669.24	Professional		$342.80	$496.86	$669.24
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $83.16 / $123.87 / $166.47	Professional	26	$83.16	$123.87	$166.47
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $259.64 / $375.14 / $505.80	Professional	TC	$259.64	$375.14	$505.80
United Facility/Professional Professional Modifier Low / Median / High Price $213.50 / $309.02 / $677.95	Professional		$213.50	$309.02	$677.95
United Facility/Professional Professional Modifier 26 Low / Median / High Price $55.52 / $78.39 / $176.30	Professional	26	$55.52	$78.39	$176.30
United Facility/Professional Professional Modifier TC Low / Median / High Price $157.97 / $286.14 / $524.38	Professional	TC	$157.97	$286.14	$524.38
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $268.81 / $268.81 / $268.81	Professional		$268.81	$268.81	$268.81
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $62.65 / $62.65 / $62.65	Professional	26	$62.65	$62.65	$62.65
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $206.15 / $206.15 / $206.15	Professional	TC	$206.15	$206.15	$206.15