Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $57.78 / $62.98 / $142.83	Facility	26	$57.78	$62.98	$142.83
Aetna Facility/Professional Professional Modifier Low / Median / High Price $134.41 / $176.62 / $371.00	Professional		$134.41	$176.62	$371.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $46.58 / $61.40 / $119.29	Professional	26	$46.58	$61.40	$119.29
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $88.29 / $118.84 / $241.62	Professional	TC	$88.29	$118.84	$241.62
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $134.58 / $261.24 / $392.47	Professional		$134.58	$261.24	$392.47
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $53.21 / $87.80 / $132.44	Professional	26	$53.21	$87.80	$132.44
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $165.89 / $165.89 / $194.49	Professional	TC	$165.89	$165.89	$194.49
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $156.94 / $479.84 / $479.84	Facility	26	$156.94	$479.84	$479.84
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $193.31 / $338.01 / $1,213.88	Professional		$193.31	$338.01	$1,213.88
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $70.22 / $121.11 / $422.55	Professional	26	$70.22	$121.11	$422.55
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $126.13 / $219.75 / $791.33	Professional	TC	$126.13	$219.75	$791.33
Cigna Facility/Professional Professional Modifier Low / Median / High Price $147.08 / $270.85 / $487.63	Professional		$147.08	$270.85	$487.63
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $50.52 / $92.64 / $161.41	Professional	26	$50.52	$92.64	$161.41
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $94.47 / $174.29 / $303.11	Professional	TC	$94.47	$174.29	$303.11
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $61.91 / $115.56 / $290.81	Facility	26	$61.91	$115.56	$290.81
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $160.16 / $321.89 / $424.46	Professional		$160.16	$321.89	$424.46
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $55.59 / $109.47 / $140.63	Professional	26	$55.59	$109.47	$140.63
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $104.56 / $210.16 / $282.97	Professional	TC	$104.56	$210.16	$282.97
Molina Facility/Professional Professional Modifier Low / Median / High Price $29.78 / $148.47 / $309.40	Professional		$29.78	$148.47	$309.40
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $83.54 / $100.28 / $101.84	Facility	26	$83.54	$100.28	$101.84
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $106.95 / $106.95 / $106.95	Professional		$106.95	$106.95	$106.95
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $61.10 / $83.54 / $107.50	Professional	26	$61.10	$83.54	$107.50
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $146.83 / $175.93 / $181.57	Professional	TC	$146.83	$175.93	$181.57
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $68.86 / $68.86 / $69.45	Facility	26	$68.86	$68.86	$69.45
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $220.12 / $332.65 / $402.70	Professional		$220.12	$332.65	$402.70
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $78.59 / $119.30 / $142.47	Professional	26	$78.59	$119.30	$142.47
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $141.25 / $209.75 / $257.99	Professional	TC	$141.25	$209.75	$257.99
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $156.94 / $156.94 / $272.64	Facility	26	$156.94	$156.94	$272.64
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $196.35 / $289.76 / $396.94	Professional		$196.35	$289.76	$396.94
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $70.22 / $104.44 / $142.63	Professional	26	$70.22	$104.44	$142.63
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $126.13 / $187.53 / $254.31	Professional	TC	$126.13	$187.53	$254.31
United Facility/Professional Professional Modifier Low / Median / High Price $134.36 / $174.29 / $418.89	Professional		$134.36	$174.29	$418.89
United Facility/Professional Professional Modifier 26 Low / Median / High Price $46.33 / $60.72 / $147.10	Professional	26	$46.33	$60.72	$147.10
United Facility/Professional Professional Modifier TC Low / Median / High Price $88.03 / $114.20 / $274.45	Professional	TC	$88.03	$114.20	$274.45
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $158.33 / $158.33 / $158.33	Professional		$158.33	$158.33	$158.33
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $53.21 / $53.21 / $53.21	Professional	26	$53.21	$53.21	$53.21
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $105.13 / $105.13 / $105.13	Professional	TC	$105.13	$105.13	$105.13