Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $48.40 / $53.25 / $109.11	Facility	26	$48.40	$53.25	$109.11
Aetna Facility/Professional Professional Modifier Low / Median / High Price $179.96 / $256.10 / $589.50	Professional		$179.96	$256.10	$589.50
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $28.30 / $48.33 / $108.90	Professional	26	$28.30	$48.33	$108.90
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $151.80 / $215.34 / $431.32	Professional	TC	$151.80	$215.34	$431.32
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $146.97 / $300.02 / $399.84	Professional		$146.97	$300.02	$399.84
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $30.16 / $59.99 / $71.98	Professional	26	$30.16	$59.99	$71.98
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $87.82 / $189.47 / $210.00	Facility	26	$87.82	$189.47	$210.00
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $266.11 / $480.92 / $1,651.35	Professional		$266.11	$480.92	$1,651.35
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $51.18 / $85.98 / $422.69	Professional	26	$51.18	$85.98	$422.69
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $213.44 / $381.80 / $1,414.75	Professional	TC	$213.44	$381.80	$1,414.75
Cigna Facility/Professional Professional Modifier Low / Median / High Price $240.46 / $390.55 / $622.57	Professional		$240.46	$390.55	$622.57
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $39.54 / $66.79 / $119.79	Professional	26	$39.54	$66.79	$119.79
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $196.39 / $322.86 / $512.40	Professional	TC	$196.39	$322.86	$512.40
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $35.34 / $69.14 / $134.78	Facility	26	$35.34	$69.14	$134.78
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $224.75 / $424.85 / $608.27	Professional		$224.75	$424.85	$608.27
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $35.34 / $67.15 / $100.37	Professional	26	$35.34	$67.15	$100.37
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $198.71 / $349.28 / $519.37	Professional	TC	$198.71	$349.28	$519.37
Molina Facility/Professional Professional Modifier Low / Median / High Price $35.65 / $196.64 / $456.88	Professional		$35.65	$196.64	$456.88
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $55.86 / $73.36 / $76.38	Facility	26	$55.86	$73.36	$76.38
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $40.58 / $55.04 / $80.37	Professional	26	$40.58	$55.04	$80.37
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $209.30 / $302.17 / $385.92	Professional	TC	$209.30	$302.17	$385.92
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $51.18 / $51.18 / $51.64	Facility	26	$51.18	$51.18	$51.64
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $295.38 / $436.00 / $534.26	Professional		$295.38	$436.00	$534.26
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $57.85 / $85.98 / $104.98	Professional	26	$57.85	$85.98	$104.98
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $237.13 / $354.49 / $429.28	Professional	TC	$237.13	$354.49	$429.28
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $446.45 / $446.45 / $782.93	Facility	26	$446.45	$446.45	$782.93
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $266.11 / $374.72 / $504.74	Professional		$266.11	$374.72	$504.74
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $52.67 / $73.63 / $99.18	Professional	26	$52.67	$73.63	$99.18
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $213.44 / $301.08 / $405.56	Professional	TC	$213.44	$301.08	$405.56
United Facility/Professional Professional Modifier Low / Median / High Price $234.23 / $365.17 / $566.54	Professional		$234.23	$365.17	$566.54
United Facility/Professional Professional Modifier 26 Low / Median / High Price $40.04 / $66.67 / $111.87	Professional	26	$40.04	$66.67	$111.87
United Facility/Professional Professional Modifier TC Low / Median / High Price $193.20 / $312.00 / $453.04	Professional	TC	$193.20	$312.00	$453.04
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $216.13 / $216.13 / $216.13	Professional		$216.13	$216.13	$216.13
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $38.90 / $38.90 / $38.90	Professional	26	$38.90	$38.90	$38.90
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $177.23 / $177.23 / $177.23	Professional	TC	$177.23	$177.23	$177.23