Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $30.03 / $49.30 / $67.75	Facility	26	$30.03	$49.30	$67.75
Aetna Facility/Professional Professional Modifier Low / Median / High Price $165.59 / $245.36 / $475.98	Professional		$165.59	$245.36	$475.98
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $23.30 / $30.04 / $65.09	Professional	26	$23.30	$30.04	$65.09
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $142.21 / $212.43 / $395.07	Professional	TC	$142.21	$212.43	$395.07
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $159.32 / $294.74 / $299.52	Professional		$159.32	$294.74	$299.52
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $44.71 / $44.71 / $44.71	Professional	26	$44.71	$44.71	$44.71
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $54.52 / $236.27 / $236.27	Facility	26	$54.52	$236.27	$236.27
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $227.52 / $409.58 / $1,431.47	Professional		$227.52	$409.58	$1,431.47
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $32.61 / $54.99 / $293.89	Professional	26	$32.61	$54.99	$293.89
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $185.72 / $343.46 / $1,288.22	Professional	TC	$185.72	$343.46	$1,288.22
Cigna Facility/Professional Professional Modifier Low / Median / High Price $203.03 / $329.10 / $526.90	Professional		$203.03	$329.10	$526.90
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $26.32 / $43.52 / $74.03	Professional	26	$26.32	$43.52	$74.03
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $174.09 / $280.51 / $458.59	Professional	TC	$174.09	$280.51	$458.59
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $23.15 / $49.68 / $81.99	Facility	26	$23.15	$49.68	$81.99
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $191.24 / $353.80 / $522.17	Professional		$191.24	$353.80	$522.17
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $22.84 / $48.82 / $62.61	Professional	26	$22.84	$48.82	$62.61
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $169.02 / $303.05 / $451.87	Professional	TC	$169.02	$303.05	$451.87
Molina Facility/Professional Professional Modifier Low / Median / High Price $35.35 / $189.18 / $398.16	Professional		$35.35	$189.18	$398.16
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $36.26 / $45.56 / $47.82	Facility	26	$36.26	$45.56	$47.82
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $28.94 / $41.30 / $50.06	Professional	26	$28.94	$41.30	$50.06
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $165.46 / $254.84 / $326.86	Professional	TC	$165.46	$254.84	$326.86
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $31.99 / $31.99 / $32.61	Facility	26	$31.99	$31.99	$32.61
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $243.32 / $365.90 / $449.90	Professional		$243.32	$365.90	$449.90
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $36.60 / $54.02 / $65.61	Professional	26	$36.60	$54.02	$65.61
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $206.72 / $312.54 / $384.29	Professional	TC	$206.72	$312.54	$384.29
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $459.43 / $459.43 / $513.03	Facility	26	$459.43	$459.43	$513.03
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $218.99 / $312.51 / $425.04	Professional		$218.99	$312.51	$425.04
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $33.26 / $46.02 / $61.99	Professional	26	$33.26	$46.02	$61.99
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $185.72 / $266.70 / $363.06	Professional	TC	$185.72	$266.70	$363.06
United Facility/Professional Professional Modifier Low / Median / High Price $191.70 / $308.61 / $455.72	Professional		$191.70	$308.61	$455.72
United Facility/Professional Professional Modifier 26 Low / Median / High Price $28.00 / $42.00 / $68.55	Professional	26	$28.00	$42.00	$68.55
United Facility/Professional Professional Modifier TC Low / Median / High Price $164.64 / $263.52 / $388.08	Professional	TC	$164.64	$263.52	$388.08
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $184.42 / $184.42 / $184.42	Professional		$184.42	$184.42	$184.42
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $24.17 / $24.17 / $24.17	Professional	26	$24.17	$24.17	$24.17
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $160.26 / $160.26 / $160.26	Professional	TC	$160.26	$160.26	$160.26