Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $19.55 / $31.98 / $156.58	Facility	26	$19.55	$31.98	$156.58
Aetna Facility/Professional Professional Modifier Low / Median / High Price $61.64 / $95.90 / $182.61	Professional		$61.64	$95.90	$182.61
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $14.91 / $18.89 / $39.11	Professional	26	$14.91	$18.89	$39.11
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $46.00 / $64.89 / $127.75	Professional	TC	$46.00	$64.89	$127.75
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $170.85 / $170.85 / $170.85	Professional		$170.85	$170.85	$170.85
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $50.00 / $77.22 / $77.22	Facility	26	$50.00	$77.22	$77.22
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $108.57 / $186.87 / $686.40	Professional		$108.57	$186.87	$686.40
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $23.56 / $41.26 / $140.85	Professional	26	$23.56	$41.26	$140.85
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $85.01 / $141.53 / $545.54	Professional	TC	$85.01	$141.53	$545.54
Cigna Facility/Professional Professional Modifier Low / Median / High Price $72.77 / $132.31 / $259.14	Professional		$72.77	$132.31	$259.14
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $18.09 / $31.40 / $51.97	Professional	26	$18.09	$31.40	$51.97
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $54.82 / $101.65 / $205.99	Professional	TC	$54.82	$101.65	$205.99
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $17.05 / $37.70 / $290.81	Facility	26	$17.05	$37.70	$290.81
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $73.78 / $149.43 / $211.48	Professional		$73.78	$149.43	$211.48
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $17.05 / $36.61 / $47.16	Professional	26	$17.05	$36.61	$47.16
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $56.73 / $109.59 / $164.09	Professional	TC	$56.73	$109.59	$164.09
Molina Facility/Professional Professional Modifier Low / Median / High Price $18.30 / $109.46 / $185.62	Professional		$18.30	$109.46	$185.62
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $28.04 / $33.79 / $34.68	Facility	26	$28.04	$33.79	$34.68
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $78.25 / $78.25 / $86.94	Professional		$78.25	$78.25	$86.94
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $22.43 / $28.63 / $38.22	Professional	26	$22.43	$28.63	$38.22
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $75.59 / $102.85 / $125.32	Professional	TC	$75.59	$102.85	$125.32
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $23.10 / $23.10 / $23.31	Facility	26	$23.10	$23.10	$23.31
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $120.36 / $181.43 / $223.08	Professional		$120.36	$181.43	$223.08
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $26.33 / $39.47 / $47.80	Professional	26	$26.33	$39.47	$47.80
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $93.58 / $141.53 / $175.28	Professional	TC	$93.58	$141.53	$175.28
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $211.40 / $211.40 / $385.75	Facility	26	$211.40	$211.40	$385.75
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $108.57 / $163.03 / $213.77	Professional		$108.57	$163.03	$213.77
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $24.48 / $35.29 / $47.82	Professional	26	$24.48	$35.29	$47.82
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $85.01 / $128.10 / $173.27	Professional	TC	$85.01	$128.10	$173.27
United Facility/Professional Professional Modifier Low / Median / High Price $70.06 / $88.34 / $217.69	Professional		$70.06	$88.34	$217.69
United Facility/Professional Professional Modifier 26 Low / Median / High Price $17.80 / $20.65 / $48.73	Professional	26	$17.80	$20.65	$48.73
United Facility/Professional Professional Modifier TC Low / Median / High Price $52.81 / $70.52 / $167.01	Professional	TC	$52.81	$70.52	$167.01
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $92.35 / $92.35 / $92.35	Professional		$92.35	$92.35	$92.35
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $18.00 / $18.00 / $18.00	Professional	26	$18.00	$18.00	$18.00
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $74.34 / $74.34 / $74.34	Professional	TC	$74.34	$74.34	$74.34