Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $149.52 / $282.30 / $518.67	Facility	26	$149.52	$282.30	$518.67
Aetna Facility/Professional Professional Modifier Low / Median / High Price $255.18 / $299.02 / $733.46	Professional		$255.18	$299.02	$733.46
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $131.81 / $156.29 / $342.12	Professional	26	$131.81	$156.29	$342.12
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $123.37 / $148.33 / $321.64	Professional	TC	$123.37	$148.33	$321.64
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $319.32 / $525.41 / $759.48	Professional		$319.32	$525.41	$759.48
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $121.06 / $151.33 / $328.34	Professional	26	$121.06	$151.33	$328.34
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $201.13 / $699.38 / $699.38	Facility	26	$201.13	$699.38	$699.38
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $384.38 / $672.70 / $2,455.73	Professional		$384.38	$672.70	$2,455.73
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $207.02 / $356.83 / $1,260.23	Professional	26	$207.02	$356.83	$1,260.23
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $186.91 / $315.87 / $1,195.50	Professional	TC	$186.91	$315.87	$1,195.50
Cigna Facility/Professional Professional Modifier Low / Median / High Price $352.61 / $583.82 / $913.72	Professional		$352.61	$583.82	$913.72
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $186.67 / $305.79 / $483.62	Professional	26	$186.67	$305.79	$483.62
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $169.42 / $284.33 / $447.46	Professional	TC	$169.42	$284.33	$447.46
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $140.43 / $337.47 / $1,073.72	Facility	26	$140.43	$337.47	$1,073.72
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $283.64 / $631.60 / $820.48	Professional		$283.64	$631.60	$820.48
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $142.36 / $327.54 / $406.20	Professional	26	$142.36	$327.54	$406.20
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $142.91 / $311.47 / $413.31	Professional	TC	$142.91	$311.47	$413.31
Molina Facility/Professional Professional Modifier Low / Median / High Price $48.36 / $278.06 / $619.93	Professional		$48.36	$278.06	$619.93
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $207.27 / $292.12 / $303.51	Facility	26	$207.27	$292.12	$303.51
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $199.32 / $249.15 / $303.51	Professional	26	$199.32	$249.15	$303.51
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $191.21 / $225.57 / $274.02	Professional	TC	$191.21	$225.57	$274.02
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $201.13 / $201.13 / $207.02	Facility	26	$201.13	$201.13	$207.02
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $438.70 / $657.10 / $784.37	Professional		$438.70	$657.10	$784.37
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $232.71 / $345.32 / $412.78	Professional	26	$232.71	$345.32	$412.78
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $206.72 / $311.77 / $371.59	Professional	TC	$206.72	$311.77	$371.59
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $657.04 / $657.04 / $1,088.88	Facility	26	$657.04	$657.04	$1,088.88
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $384.38 / $590.47 / $774.25	Professional		$384.38	$590.47	$774.25
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $205.13 / $310.31 / $406.88	Professional	26	$205.13	$310.31	$406.88
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $179.26 / $276.72 / $370.64	Professional	TC	$179.26	$276.72	$370.64
United Facility/Professional Professional Modifier Low / Median / High Price $355.12 / $369.91 / $775.92	Professional		$355.12	$369.91	$775.92
United Facility/Professional Professional Modifier 26 Low / Median / High Price $174.40 / $196.69 / $392.39	Professional	26	$174.40	$196.69	$392.39
United Facility/Professional Professional Modifier TC Low / Median / High Price $159.97 / $173.22 / $365.60	Professional	TC	$159.97	$173.22	$365.60
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $327.07 / $327.07 / $327.07	Professional		$327.07	$327.07	$327.07
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $164.17 / $164.17 / $164.17	Professional	26	$164.17	$164.17	$164.17
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $162.90 / $162.90 / $162.90	Professional	TC	$162.90	$162.90	$162.90