Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $113.06 / $180.53 / $234.33	Facility	26	$113.06	$180.53	$234.33
Aetna Facility/Professional Professional Modifier Low / Median / High Price $246.04 / $349.28 / $1,082.00	Professional		$246.04	$349.28	$1,082.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $86.76 / $113.06 / $361.00	Professional	26	$86.76	$113.06	$361.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $154.16 / $207.55 / $453.56	Professional	TC	$154.16	$207.55	$453.56
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $263.22 / $429.69 / $633.37	Professional		$263.22	$429.69	$633.37
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $97.62 / $140.07 / $158.32	Professional	26	$97.62	$140.07	$158.32
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $147.59 / $366.35 / $366.35	Facility	26	$147.59	$366.35	$366.35
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $322.48 / $545.88 / $2,380.40	Professional		$322.48	$545.88	$2,380.40
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $116.86 / $201.10 / $667.65	Professional	26	$116.86	$201.10	$667.65
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $209.75 / $357.80 / $1,326.45	Professional	TC	$209.75	$357.80	$1,326.45
Cigna Facility/Professional Professional Modifier Low / Median / High Price $291.04 / $449.12 / $748.37	Professional		$291.04	$449.12	$748.37
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $100.53 / $153.97 / $263.02	Professional	26	$100.53	$153.97	$263.02
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $177.41 / $290.00 / $507.58	Professional	TC	$177.41	$290.00	$507.58
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $88.23 / $173.22 / $286.42	Facility	26	$88.23	$173.22	$286.42
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $230.92 / $465.95 / $626.94	Professional		$230.92	$465.95	$626.94
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $84.19 / $168.79 / $235.30	Professional	26	$84.19	$168.79	$235.30
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $149.72 / $299.47 / $411.59	Professional	TC	$149.72	$299.47	$411.59
Molina Facility/Professional Professional Modifier Low / Median / High Price $39.60 / $219.59 / $497.54	Professional		$39.60	$219.59	$497.54
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $132.30 / $160.36 / $162.13	Facility	26	$132.30	$160.36	$162.13
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $96.88 / $142.19 / $184.53	Professional	26	$96.88	$142.19	$184.53
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $206.35 / $274.36 / $365.30	Professional	TC	$206.35	$274.36	$365.30
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $110.53 / $110.53 / $110.59	Facility	26	$110.53	$110.53	$110.59
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $357.24 / $530.55 / $652.36	Professional		$357.24	$530.55	$652.36
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $124.75 / $184.48 / $226.83	Professional	26	$124.75	$184.48	$226.83
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $231.68 / $346.08 / $425.53	Professional	TC	$231.68	$346.08	$425.53
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 $322.48 / $457.55 / $616.30	Professional		$322.48	$457.55	$616.30
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $112.73 / $159.09 / $214.29	Professional	26	$112.73	$159.09	$214.29
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $209.75 / $298.45 / $402.02	Professional	TC	$209.75	$298.45	$402.02
United Facility/Professional Professional Modifier Low / Median / High Price $272.37 / $397.79 / $669.10	Professional		$272.37	$397.79	$669.10
United Facility/Professional Professional Modifier 26 Low / Median / High Price $95.55 / $145.21 / $243.10	Professional	26	$95.55	$145.21	$243.10
United Facility/Professional Professional Modifier TC Low / Median / High Price $173.16 / $252.58 / $435.44	Professional	TC	$173.16	$252.58	$435.44
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $260.42 / $260.42 / $260.42	Professional		$260.42	$260.42	$260.42
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $84.89 / $84.89 / $84.89	Professional	26	$84.89	$84.89	$84.89
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $175.53 / $175.53 / $175.53	Professional	TC	$175.53	$175.53	$175.53