Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $37.25 / $70.29 / $125.39	Facility	26	$37.25	$70.29	$125.39
Aetna Facility/Professional Professional Modifier Low / Median / High Price $191.15 / $285.35 / $713.23	Professional		$191.15	$285.35	$713.23
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $32.11 / $42.65 / $99.65	Professional	26	$32.11	$42.65	$99.65
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $158.51 / $266.55 / $601.20	Professional	TC	$158.51	$266.55	$601.20
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $208.67 / $296.27 / $757.38	Professional		$208.67	$296.27	$757.38
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $31.48 / $59.26 / $74.43	Professional	26	$31.48	$59.26	$74.43
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $50.28 / $463.50 / $463.50	Facility	26	$50.28	$463.50	$463.50
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $367.75 / $614.91 / $2,395.00	Professional		$367.75	$614.91	$2,395.00
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $51.28 / $86.40 / $719.00	Professional	26	$51.28	$86.40	$719.00
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $316.47 / $550.54 / $2,027.25	Professional	TC	$316.47	$550.54	$2,027.25
Cigna Facility/Professional Professional Modifier Low / Median / High Price $335.16 / $527.17 / $882.53	Professional		$335.16	$527.17	$882.53
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $46.27 / $72.80 / $119.62	Professional	26	$46.27	$72.80	$119.62
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $291.94 / $455.72 / $762.91	Professional	TC	$291.94	$455.72	$762.91
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $34.10 / $79.01 / $399.23	Facility	26	$34.10	$79.01	$399.23
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $258.45 / $510.05 / $811.51	Professional		$258.45	$510.05	$811.51
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $35.35 / $77.63 / $98.63	Professional	26	$35.35	$77.63	$98.63
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $246.45 / $439.66 / $712.87	Professional	TC	$246.45	$439.66	$712.87
Molina Facility/Professional Professional Modifier Low / Median / High Price $49.77 / $327.37 / $639.57	Professional		$49.77	$327.37	$639.57
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $50.47 / $69.01 / $75.04	Facility	26	$50.47	$69.01	$75.04
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $41.60 / $58.80 / $75.19	Professional	26	$41.60	$58.80	$75.19
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $223.33 / $374.49 / $475.17	Professional	TC	$223.33	$374.49	$475.17
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $50.28 / $50.28 / $51.18	Facility	26	$50.28	$50.28	$51.18
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $414.56 / $615.94 / $735.05	Professional		$414.56	$615.94	$735.05
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $56.64 / $85.98 / $102.96	Professional	26	$56.64	$85.98	$102.96
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $356.51 / $530.55 / $637.63	Professional	TC	$356.51	$530.55	$637.63
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $246.13 / $246.13 / $422.45	Facility	26	$246.13	$246.13	$422.45
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $367.75 / $555.53 / $733.92	Professional		$367.75	$555.53	$733.92
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $51.28 / $76.72 / $100.60	Professional	26	$51.28	$76.72	$100.60
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $316.47 / $481.63 / $638.27	Professional	TC	$316.47	$481.63	$638.27
United Facility/Professional Professional Modifier Low / Median / High Price $232.64 / $354.13 / $735.74	Professional		$232.64	$354.13	$735.74
United Facility/Professional Professional Modifier 26 Low / Median / High Price $42.16 / $48.28 / $103.02	Professional	26	$42.16	$48.28	$103.02
United Facility/Professional Professional Modifier TC Low / Median / High Price $190.47 / $305.85 / $601.15	Professional	TC	$190.47	$305.85	$601.15
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $312.68 / $312.68 / $312.68	Professional		$312.68	$312.68	$312.68
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $40.22 / $40.22 / $40.22	Professional	26	$40.22	$40.22	$40.22
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $272.45 / $272.45 / $272.45	Professional	TC	$272.45	$272.45	$272.45