Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $85.29 / $140.29 / $687.78	Facility	26	$85.29	$140.29	$687.78
Aetna Facility/Professional Professional Modifier Low / Median / High Price $209.31 / $402.08 / $608.00	Professional		$209.31	$402.08	$608.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $67.56 / $116.83 / $166.95	Professional	26	$67.56	$116.83	$166.95
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $143.86 / $276.50 / $390.31	Professional	TC	$143.86	$276.50	$390.31
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $173.62 / $413.85 / $416.13	Professional		$173.62	$413.85	$416.13
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $41.71 / $41.71 / $41.71	Professional	26	$41.71	$41.71	$41.71
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $446.45 / $707.68 / $707.68	Facility	26	$446.45	$707.68	$707.68
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $318.32 / $545.00 / $1,936.80	Professional		$318.32	$545.00	$1,936.80
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $103.95 / $179.29 / $621.53	Professional	26	$103.95	$179.29	$621.53
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $214.37 / $375.56 / $1,315.28	Professional	TC	$214.37	$375.56	$1,315.28
Cigna Facility/Professional Professional Modifier Low / Median / High Price $236.93 / $445.39 / $750.00	Professional		$236.93	$445.39	$750.00
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $75.44 / $138.66 / $238.05	Professional	26	$75.44	$138.66	$238.05
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $160.87 / $306.73 / $504.89	Professional	TC	$160.87	$306.73	$504.89
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $90.04 / $168.72 / $227.81	Facility	26	$90.04	$168.72	$227.81
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $272.39 / $511.24 / $679.25	Professional		$272.39	$511.24	$679.25
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $83.94 / $168.72 / $208.37	Professional	26	$83.94	$168.72	$208.37
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $183.36 / $358.53 / $476.77	Professional	TC	$183.36	$358.53	$476.77
Molina Facility/Professional Professional Modifier Low / Median / High Price $39.71 / $222.56 / $499.23	Professional		$39.71	$222.56	$499.23
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $123.20 / $148.53 / $152.09	Facility	26	$123.20	$148.53	$152.09
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $160.34 / $160.34 / $160.34	Professional		$160.34	$160.34	$160.34
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $86.79 / $112.56 / $150.08	Professional	26	$86.79	$112.56	$150.08
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $241.98 / $267.08 / $302.17	Professional	TC	$241.98	$267.08	$302.17
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $101.93 / $101.93 / $102.37	Facility	26	$101.93	$101.93	$102.37
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $354.15 / $522.74 / $642.60	Professional		$354.15	$522.74	$642.60
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $116.50 / $175.82 / $209.96	Professional	26	$116.50	$175.82	$209.96
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $237.65 / $354.32 / $435.72	Professional	TC	$237.65	$354.32	$435.72
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $446.45 / $446.45 / $777.03	Facility	26	$446.45	$446.45	$777.03
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $318.32 / $462.38 / $633.41	Professional		$318.32	$462.38	$633.41
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $103.95 / $153.91 / $210.20	Professional	26	$103.95	$153.91	$210.20
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $214.37 / $312.08 / $433.40	Professional	TC	$214.37	$312.08	$433.40
United Facility/Professional Professional Modifier Low / Median / High Price $217.18 / $458.33 / $855.97	Professional		$217.18	$458.33	$855.97
United Facility/Professional Professional Modifier 26 Low / Median / High Price $69.63 / $89.47 / $238.22	Professional	26	$69.63	$89.47	$238.22
United Facility/Professional Professional Modifier TC Low / Median / High Price $147.55 / $337.42 / $698.66	Professional	TC	$147.55	$337.42	$698.66
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $252.20 / $252.20 / $252.20	Professional		$252.20	$252.20	$252.20
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $78.80 / $78.80 / $78.80	Professional	26	$78.80	$78.80	$78.80
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $173.40 / $173.40 / $173.40	Professional	TC	$173.40	$173.40	$173.40