Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $77.59 / $128.38 / $228.02	Facility	26	$77.59	$128.38	$228.02
Aetna Facility/Professional Professional Modifier Low / Median / High Price $262.30 / $475.00 / $875.80	Professional		$262.30	$475.00	$875.80
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $77.59 / $140.00 / $309.10	Professional	26	$77.59	$140.00	$309.10
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $184.71 / $335.00 / $566.16	Professional	TC	$184.71	$335.00	$566.16
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $155.53 / $185.05 / $581.16	Professional		$155.53	$185.05	$581.16
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $106.99 / $118.32 / $183.36	Professional	26	$106.99	$118.32	$183.36
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $647.12 / $647.12 / $647.12	Facility	26	$647.12	$647.12	$647.12
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $284.13 / $497.60 / $2,831.41	Professional		$284.13	$497.60	$2,831.41
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $95.17 / $164.68 / $579.54	Professional	26	$95.17	$164.68	$579.54
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $188.96 / $352.15 / $2,465.48	Professional	TC	$188.96	$352.15	$2,465.48
Cigna Facility/Professional Professional Modifier Low / Median / High Price $220.16 / $487.91 / $819.74	Professional		$220.16	$487.91	$819.74
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $68.84 / $125.43 / $217.70	Professional	26	$68.84	$125.43	$217.70
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $148.68 / $342.58 / $656.18	Professional	TC	$148.68	$342.58	$656.18
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $76.58 / $156.68 / $698.97	Facility	26	$76.58	$156.68	$698.97
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $317.52 / $567.58 / $1,126.00	Professional		$317.52	$567.58	$1,126.00
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $67.89 / $146.47 / $190.13	Professional	26	$67.89	$146.47	$190.13
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $240.57 / $421.11 / $936.06	Professional	TC	$240.57	$421.11	$936.06
Molina Facility/Professional Professional Modifier Low / Median / High Price $37.16 / $177.58 / $385.40	Professional		$37.16	$177.58	$385.40
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $110.24 / $135.19 / $139.36	Facility	26	$110.24	$135.19	$139.36
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $160.34 / $178.16 / $178.16	Professional		$160.34	$178.16	$178.16
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $83.21 / $123.60 / $156.00	Professional	26	$83.21	$123.60	$156.00
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $257.18 / $416.30 / $601.29	Professional	TC	$257.18	$416.30	$601.29
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $93.32 / $93.32 / $93.69	Facility	26	$93.32	$93.32	$93.69
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $316.00 / $482.86 / $598.10	Professional		$316.00	$482.86	$598.10
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $106.34 / $160.12 / $192.15	Professional	26	$106.34	$160.12	$192.15
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $209.29 / $319.81 / $406.83	Professional	TC	$209.29	$319.81	$406.83
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $446.45 / $446.45 / $782.93	Facility	26	$446.45	$446.45	$782.93
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $284.13 / $417.97 / $620.01	Professional		$284.13	$417.97	$620.01
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $95.17 / $141.86 / $191.30	Professional	26	$95.17	$141.86	$191.30
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $188.96 / $276.11 / $426.13	Professional	TC	$188.96	$276.11	$426.13
United Facility/Professional Professional Modifier Low / Median / High Price $194.49 / $355.54 / $683.38	Professional		$194.49	$355.54	$683.38
United Facility/Professional Professional Modifier 26 Low / Median / High Price $63.30 / $85.28 / $202.62	Professional	26	$63.30	$85.28	$202.62
United Facility/Professional Professional Modifier TC Low / Median / High Price $130.68 / $278.07 / $466.29	Professional	TC	$130.68	$278.07	$466.29
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $225.38 / $225.38 / $225.38	Professional		$225.38	$225.38	$225.38
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $71.70 / $71.70 / $71.70	Professional	26	$71.70	$71.70	$71.70
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $153.66 / $153.66 / $153.66	Professional	TC	$153.66	$153.66	$153.66