Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $203.63 / $272.66 / $426.49	Facility	26	$203.63	$272.66	$426.49
Aetna Facility/Professional Professional Modifier Low / Median / High Price $224.29 / $289.19 / $627.85	Professional		$224.29	$289.19	$627.85
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $138.82 / $169.12 / $340.77	Professional	26	$138.82	$169.12	$340.77
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $85.48 / $116.17 / $219.58	Professional	TC	$85.48	$116.17	$219.58
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $239.88 / $383.81 / $479.76	Professional		$239.88	$383.81	$479.76
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $141.43 / $269.94 / $302.66	Professional	26	$141.43	$269.94	$302.66
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $210.68 / $699.38 / $699.38	Facility	26	$210.68	$699.38	$699.38
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $272.36 / $506.90 / $2,095.65	Professional		$272.36	$506.90	$2,095.65
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $180.64 / $317.06 / $1,281.00	Professional	26	$180.64	$317.06	$1,281.00
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $110.47 / $191.26 / $814.65	Professional	TC	$110.47	$191.26	$814.65
Cigna Facility/Professional Professional Modifier Low / Median / High Price $217.08 / $424.36 / $751.99	Professional		$217.08	$424.36	$751.99
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $165.36 / $277.88 / $463.99	Professional	26	$165.36	$277.88	$463.99
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $103.30 / $176.17 / $288.01	Professional	TC	$103.30	$176.17	$288.01
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $141.97 / $237.94 / $404.68	Facility	26	$141.97	$237.94	$404.68
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $229.04 / $368.44 / $643.65	Professional		$229.04	$368.44	$643.65
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $135.24 / $220.67 / $380.60	Professional	26	$135.24	$220.67	$380.60
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $91.76 / $145.21 / $260.62	Professional	TC	$91.76	$145.21	$260.62
Molina Facility/Professional Professional Modifier Low / Median / High Price $42.81 / $219.05 / $503.46	Professional		$42.81	$219.05	$503.46
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $221.48 / $304.18 / $308.87	Facility	26	$221.48	$304.18	$308.87
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $200.03 / $273.16 / $320.20	Professional	26	$200.03	$273.16	$320.20
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $127.11 / $173.94 / $203.05	Professional	TC	$127.11	$173.94	$203.05
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $208.38 / $208.38 / $210.68	Facility	26	$208.38	$208.38	$210.68
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $355.20 / $551.50 / $677.48	Professional		$355.20	$551.50	$677.48
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $217.38 / $343.47 / $418.17	Professional	26	$217.38	$343.47	$418.17
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $131.66 / $210.90 / $261.51	Professional	TC	$131.66	$210.90	$261.51
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $946.29 / $946.29 / $1,497.68	Facility	26	$946.29	$946.29	$1,497.68
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $344.19 / $481.36 / $655.27	Professional		$344.19	$481.36	$655.27
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $212.52 / $299.87 / $406.98	Professional	26	$212.52	$299.87	$406.98
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $131.66 / $183.13 / $250.52	Professional	TC	$131.66	$183.13	$250.52
United Facility/Professional Professional Modifier Low / Median / High Price $297.37 / $444.87 / $735.58	Professional		$297.37	$444.87	$735.58
United Facility/Professional Professional Modifier 26 Low / Median / High Price $189.80 / $265.06 / $450.79	Professional	26	$189.80	$265.06	$450.79
United Facility/Professional Professional Modifier TC Low / Median / High Price $116.76 / $178.60 / $282.04	Professional	TC	$116.76	$178.60	$282.04
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $200.43 / $239.88 / $267.54	Professional		$200.43	$239.88	$267.54
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $127.54 / $151.22 / $163.60	Professional	26	$127.54	$151.22	$163.60
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $72.88 / $88.66 / $103.94	Professional	TC	$72.88	$88.66	$103.94