Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $123.12 / $193.29 / $306.33	Facility	26	$123.12	$193.29	$306.33
Aetna Facility/Professional Professional Modifier Low / Median / High Price $359.20 / $475.00 / $1,001.83	Professional		$359.20	$475.00	$1,001.83
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $107.14 / $140.00 / $289.50	Professional	26	$107.14	$140.00	$289.50
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $245.66 / $343.92 / $502.80	Professional	TC	$245.66	$343.92	$502.80
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $346.02 / $652.97 / $1,031.57	Professional		$346.02	$652.97	$1,031.57
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $84.97 / $175.26 / $210.79	Professional	26	$84.97	$175.26	$210.79
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $384.48 / $384.48 / $521.33	Professional	TC	$384.48	$384.48	$521.33
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $1,020.08 / $1,020.08 / $1,020.08	Facility	26	$1,020.08	$1,020.08	$1,020.08
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $483.05 / $851.76 / $3,037.28	Professional		$483.05	$851.76	$3,037.28
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $149.22 / $257.27 / $896.93	Professional	26	$149.22	$257.27	$896.93
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $351.58 / $602.29 / $2,140.35	Professional	TC	$351.58	$602.29	$2,140.35
Cigna Facility/Professional Professional Modifier Low / Median / High Price $371.22 / $703.98 / $1,147.24	Professional		$371.22	$703.98	$1,147.24
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $108.32 / $198.23 / $343.16	Professional	26	$108.32	$198.23	$343.16
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $261.32 / $505.75 / $821.79	Professional	TC	$261.32	$505.75	$821.79
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $128.69 / $229.56 / $299.97	Facility	26	$128.69	$229.56	$299.97
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $422.32 / $830.01 / $1,075.83	Professional		$422.32	$830.01	$1,075.83
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $120.03 / $241.24 / $299.26	Professional	26	$120.03	$241.24	$299.26
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $302.66 / $583.66 / $785.57	Professional	TC	$302.66	$583.66	$785.57
Molina Facility/Professional Professional Modifier Low / Median / High Price $67.02 / $300.95 / $745.03	Professional		$67.02	$300.95	$745.03
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $177.65 / $214.53 / $218.42	Facility	26	$177.65	$214.53	$218.42
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $128.72 / $177.65 / $217.08	Professional	26	$128.72	$177.65	$217.08
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $393.21 / $471.65 / $542.70	Professional	TC	$393.21	$471.65	$542.70
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $146.32 / $146.32 / $147.61	Facility	26	$146.32	$146.32	$147.61
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $554.67 / $818.73 / $1,006.26	Professional		$554.67	$818.73	$1,006.26
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $167.54 / $250.00 / $303.26	Professional	26	$167.54	$250.00	$303.26
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $387.14 / $577.22 / $714.80	Professional	TC	$387.14	$577.22	$714.80
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $500.81 / $731.44 / $998.94	Professional		$500.81	$731.44	$998.94
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $149.22 / $222.62 / $303.10	Professional	26	$149.22	$222.62	$303.10
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $351.58 / $507.93 / $713.53	Professional	TC	$351.58	$507.93	$713.53
United Facility/Professional Professional Modifier Low / Median / High Price $343.26 / $686.53 / $1,235.82	Professional		$343.26	$686.53	$1,235.82
United Facility/Professional Professional Modifier 26 Low / Median / High Price $85.56 / $118.28 / $317.54	Professional	26	$85.56	$118.28	$317.54
United Facility/Professional Professional Modifier TC Low / Median / High Price $243.26 / $501.11 / $935.72	Professional	TC	$243.26	$501.11	$935.72
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $395.74 / $395.74 / $395.74	Professional		$395.74	$395.74	$395.74
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $113.94 / $113.94 / $113.94	Professional	26	$113.94	$113.94	$113.94
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $281.80 / $281.80 / $281.80	Professional	TC	$281.80	$281.80	$281.80