Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $84.05 / $126.92 / $175.12	Facility	26	$84.05	$126.92	$175.12
Aetna Facility/Professional Professional Modifier Low / Median / High Price $215.53 / $345.12 / $1,060.00	Professional		$215.53	$345.12	$1,060.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $62.52 / $87.29 / $287.61	Professional	26	$62.52	$87.29	$287.61
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $152.75 / $231.92 / $468.84	Professional	TC	$152.75	$231.92	$468.84
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $620.95 / $620.95 / $620.95	Professional		$620.95	$620.95	$620.95
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $61.70 / $100.99 / $117.72	Professional	26	$61.70	$100.99	$117.72
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $138.28 / $281.01 / $314.00	Facility	26	$138.28	$281.01	$314.00
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $308.62 / $556.66 / $1,891.20	Professional		$308.62	$556.66	$1,891.20
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $86.29 / $151.97 / $507.29	Professional	26	$86.29	$151.97	$507.29
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $224.99 / $397.57 / $1,395.15	Professional	TC	$224.99	$397.57	$1,395.15
Cigna Facility/Professional Professional Modifier Low / Median / High Price $258.27 / $415.95 / $714.10	Professional		$258.27	$415.95	$714.10
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $72.92 / $113.58 / $191.85	Professional	26	$72.92	$113.58	$191.85
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $186.14 / $303.62 / $534.82	Professional	TC	$186.14	$303.62	$534.82
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $61.32 / $129.58 / $214.53	Facility	26	$61.32	$129.58	$214.53
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $228.54 / $453.59 / $635.52	Professional		$228.54	$453.59	$635.52
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $59.76 / $126.24 / $165.79	Professional	26	$59.76	$126.24	$165.79
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $159.26 / $317.39 / $477.46	Professional	TC	$159.26	$317.39	$477.46
Molina Facility/Professional Professional Modifier Low / Median / High Price $41.53 / $232.19 / $486.37	Professional		$41.53	$232.19	$486.37
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $95.55 / $119.21 / $123.08	Facility	26	$95.55	$119.21	$123.08
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $84.15 / $115.20 / $129.03	Professional	26	$84.15	$115.20	$129.03
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $205.43 / $279.38 / $344.04	Professional	TC	$205.43	$279.38	$344.04
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $81.99 / $81.99 / $82.26	Facility	26	$81.99	$81.99	$82.26
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $339.71 / $501.59 / $616.74	Professional		$339.71	$501.59	$616.74
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $92.79 / $137.21 / $168.71	Professional	26	$92.79	$137.21	$168.71
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $246.92 / $364.47 / $448.03	Professional	TC	$246.92	$364.47	$448.03
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $936.81 / $936.81 / $1,640.24	Facility	26	$936.81	$936.81	$1,640.24
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $308.62 / $434.20 / $591.02	Professional		$308.62	$434.20	$591.02
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $83.62 / $118.33 / $159.38	Professional	26	$83.62	$118.33	$159.38
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $224.99 / $315.72 / $429.34	Professional	TC	$224.99	$315.72	$429.34
United Facility/Professional Professional Modifier Low / Median / High Price $244.02 / $375.06 / $662.96	Professional		$244.02	$375.06	$662.96
United Facility/Professional Professional Modifier 26 Low / Median / High Price $74.20 / $107.97 / $178.87	Professional	26	$74.20	$107.97	$178.87
United Facility/Professional Professional Modifier TC Low / Median / High Price $175.02 / $267.12 / $504.87	Professional	TC	$175.02	$267.12	$504.87
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $246.26 / $246.26 / $246.26	Professional		$246.26	$246.26	$246.26
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $63.12 / $63.12 / $63.12	Professional	26	$63.12	$63.12	$63.12
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $183.15 / $183.15 / $183.15	Professional	TC	$183.15	$183.15	$183.15