Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $94.75 / $118.78 / $195.61	Facility	26	$94.75	$118.78	$195.61
Aetna Facility/Professional Professional Modifier Low / Median / High Price $204.75 / $282.38 / $942.49	Professional		$204.75	$282.38	$942.49
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $71.81 / $94.75 / $330.00	Professional	26	$71.81	$94.75	$330.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $132.93 / $179.08 / $413.99	Professional	TC	$132.93	$179.08	$413.99
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $388.77 / $388.77 / $388.77	Professional		$388.77	$388.77	$388.77
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $81.51 / $122.27 / $131.13	Professional	26	$81.51	$122.27	$131.13
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $213.72 / $251.43 / $251.43	Professional	TC	$213.72	$251.43	$251.43
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $160.72 / $557.91 / $557.91	Facility	26	$160.72	$557.91	$557.91
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $259.64 / $465.76 / $1,677.02	Professional		$259.64	$465.76	$1,677.02
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $93.79 / $158.33 / $718.23	Professional	26	$93.79	$158.33	$718.23
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $163.58 / $296.27 / $1,032.98	Professional	TC	$163.58	$296.27	$1,032.98
Cigna Facility/Professional Professional Modifier Low / Median / High Price $224.90 / $360.10 / $597.16	Professional		$224.90	$360.10	$597.16
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $82.71 / $128.53 / $221.01	Professional	26	$82.71	$128.53	$221.01
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $136.41 / $232.58 / $396.15	Professional	TC	$136.41	$232.58	$396.15
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $71.95 / $145.02 / $239.24	Facility	26	$71.95	$145.02	$239.24
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $223.30 / $416.87 / $542.84	Professional		$223.30	$416.87	$542.84
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $68.86 / $140.88 / $192.97	Professional	26	$68.86	$140.88	$192.97
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $137.33 / $270.89 / $364.43	Professional	TC	$137.33	$270.89	$364.43
Molina Facility/Professional Professional Modifier Low / Median / High Price $29.07 / $154.55 / $356.32	Professional		$29.07	$154.55	$356.32
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $98.98 / $133.90 / $138.04	Facility	26	$98.98	$133.90	$138.04
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $94.74 / $123.00 / $151.50	Professional	26	$94.74	$123.00	$151.50
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $173.09 / $230.40 / $320.26	Professional	TC	$173.09	$230.40	$320.26
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $91.96 / $91.96 / $92.31	Facility	26	$91.96	$91.96	$92.31
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $285.58 / $423.84 / $521.14	Professional		$285.58	$423.84	$521.14
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $103.62 / $153.97 / $189.33	Professional	26	$103.62	$153.97	$189.33
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $181.34 / $269.85 / $331.80	Professional	TC	$181.34	$269.85	$331.80
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 $259.64 / $365.51 / $496.83	Professional		$259.64	$365.51	$496.83
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $93.79 / $132.79 / $178.87	Professional	26	$93.79	$132.79	$178.87
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $165.86 / $233.35 / $317.95	Professional	TC	$165.86	$233.35	$317.95
United Facility/Professional Professional Modifier Low / Median / High Price $212.00 / $330.78 / $562.04	Professional		$212.00	$330.78	$562.04
United Facility/Professional Professional Modifier 26 Low / Median / High Price $80.08 / $121.20 / $202.91	Professional	26	$80.08	$121.20	$202.91
United Facility/Professional Professional Modifier TC Low / Median / High Price $129.62 / $207.14 / $340.84	Professional	TC	$129.62	$207.14	$340.84
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $206.79 / $206.79 / $206.79	Professional		$206.79	$206.79	$206.79
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $70.88 / $70.88 / $70.88	Professional	26	$70.88	$70.88	$70.88
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $135.91 / $135.91 / $135.91	Professional	TC	$135.91	$135.91	$135.91