Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $70.43 / $86.44 / $157.94	Facility	26	$70.43	$86.44	$157.94
Aetna Facility/Professional Professional Modifier Low / Median / High Price $246.93 / $362.71 / $1,067.00	Professional		$246.93	$362.71	$1,067.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $61.91 / $97.65 / $351.10	Professional	26	$61.91	$97.65	$351.10
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $162.34 / $246.35 / $544.97	Professional	TC	$162.34	$246.35	$544.97
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $258.76 / $482.05 / $521.14	Professional		$258.76	$482.05	$521.14
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $43.50 / $86.87 / $104.23	Professional	26	$43.50	$86.87	$104.23
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $127.27 / $377.88 / $377.88	Facility	26	$127.27	$377.88	$377.88
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $369.60 / $673.02 / $2,362.07	Professional		$369.60	$673.02	$2,362.07
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $80.59 / $143.59 / $507.12	Professional	26	$80.59	$143.59	$507.12
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $294.29 / $526.22 / $1,854.93	Professional	TC	$294.29	$526.22	$1,854.93
Cigna Facility/Professional Professional Modifier Low / Median / High Price $338.69 / $556.16 / $876.03	Professional		$338.69	$556.16	$876.03
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $68.29 / $113.81 / $179.97	Professional	26	$68.29	$113.81	$179.97
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $270.39 / $444.92 / $705.99	Professional	TC	$270.39	$444.92	$705.99
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $78.87 / $128.53 / $222.23	Facility	26	$78.87	$128.53	$222.23
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $339.14 / $602.36 / $879.37	Professional		$339.14	$602.36	$879.37
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $72.92 / $123.51 / $206.86	Professional	26	$72.92	$123.51	$206.86
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $260.08 / $481.00 / $702.56	Professional	TC	$260.08	$481.00	$702.56
Molina Facility/Professional Professional Modifier Low / Median / High Price $46.22 / $288.58 / $624.07	Professional		$46.22	$288.58	$624.07
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $89.00 / $106.27 / $145.19	Facility	26	$89.00	$106.27	$145.19
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $71.20 / $113.85 / $170.18	Professional	26	$71.20	$113.85	$170.18
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $257.20 / $424.11 / $519.75	Professional	TC	$257.20	$424.11	$519.75
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $73.84 / $73.84 / $74.03	Facility	26	$73.84	$73.84	$74.03
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $411.37 / $607.20 / $743.28	Professional		$411.37	$607.20	$743.28
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $84.54 / $125.39 / $154.22	Professional	26	$84.54	$125.39	$154.22
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $326.83 / $482.41 / $591.44	Professional	TC	$326.83	$482.41	$591.44
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 $369.60 / $521.32 / $707.16	Professional		$369.60	$521.32	$707.16
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $75.31 / $106.50 / $145.51	Professional	26	$75.31	$106.50	$145.51
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $294.29 / $414.82 / $558.75	Professional	TC	$294.29	$414.82	$558.75
United Facility/Professional Professional Modifier Low / Median / High Price $325.41 / $524.50 / $773.80	Professional		$325.41	$524.50	$773.80
United Facility/Professional Professional Modifier 26 Low / Median / High Price $68.47 / $114.35 / $161.38	Professional	26	$68.47	$114.35	$161.38
United Facility/Professional Professional Modifier TC Low / Median / High Price $260.39 / $395.86 / $612.11	Professional	TC	$260.39	$395.86	$612.11
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $300.14 / $300.14 / $300.14	Professional		$300.14	$300.14	$300.14
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $56.34 / $56.34 / $56.34	Professional	26	$56.34	$56.34	$56.34
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $243.80 / $243.80 / $243.80	Professional	TC	$243.80	$243.80	$243.80