Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $22.46 / $37.29 / $70.20	Facility	26	$22.46	$37.29	$70.20
Aetna Facility/Professional Professional Modifier Low / Median / High Price $73.73 / $108.45 / $213.31	Professional		$73.73	$108.45	$213.31
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $17.23 / $22.47 / $49.03	Professional	26	$17.23	$22.47	$49.03
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $55.57 / $84.17 / $165.79	Professional	TC	$55.57	$84.17	$165.79
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $77.01 / $210.14 / $210.14	Professional		$77.01	$210.14	$210.14
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $50.00 / $90.84 / $90.84	Facility	26	$50.00	$90.84	$90.84
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $135.16 / $234.56 / $856.20	Professional		$135.16	$234.56	$856.20
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $27.72 / $48.55 / $163.88	Professional	26	$27.72	$48.55	$163.88
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $105.25 / $178.85 / $692.33	Professional	TC	$105.25	$178.85	$692.33
Cigna Facility/Professional Professional Modifier Low / Median / High Price $86.76 / $157.63 / $322.20	Professional		$86.76	$157.63	$322.20
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $21.20 / $36.46 / $59.91	Professional	26	$21.20	$36.46	$59.91
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $65.95 / $124.61 / $259.37	Professional	TC	$65.95	$124.61	$259.37
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $19.84 / $44.22 / $290.81	Facility	26	$19.84	$44.22	$290.81
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $85.87 / $174.24 / $260.68	Professional		$85.87	$174.24	$260.68
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $19.84 / $42.95 / $55.38	Professional	26	$19.84	$42.95	$55.38
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $66.03 / $131.19 / $209.23	Professional	TC	$66.03	$131.19	$209.23
Molina Facility/Professional Professional Modifier Low / Median / High Price $22.16 / $124.66 / $251.57	Professional		$22.16	$124.66	$251.57
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $28.42 / $38.86 / $39.53	Facility	26	$28.42	$38.86	$39.53
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $58.23 / $58.23 / $78.25	Professional		$58.23	$58.23	$78.25
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $25.96 / $32.45 / $39.77	Professional	26	$25.96	$32.45	$39.77
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $90.85 / $130.35 / $158.79	Professional	TC	$90.85	$130.35	$158.79
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $26.96 / $26.96 / $27.18	Facility	26	$26.96	$26.96	$27.18
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $146.59 / $226.75 / $277.44	Professional		$146.59	$226.75	$277.44
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $30.97 / $45.67 / $56.17	Professional	26	$30.97	$45.67	$56.17
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $116.14 / $181.09 / $222.14	Professional	TC	$116.14	$181.09	$222.14
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 $136.29 / $202.76 / $266.07	Professional		$136.29	$202.76	$266.07
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $28.80 / $40.83 / $56.10	Professional	26	$28.80	$40.83	$56.10
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $108.57 / $162.35 / $221.30	Professional	TC	$108.57	$162.35	$221.30
United Facility/Professional Professional Modifier Low / Median / High Price $86.28 / $111.08 / $271.68	Professional		$86.28	$111.08	$271.68
United Facility/Professional Professional Modifier 26 Low / Median / High Price $20.77 / $24.18 / $56.99	Professional	26	$20.77	$24.18	$56.99
United Facility/Professional Professional Modifier TC Low / Median / High Price $65.73 / $88.72 / $216.98	Professional	TC	$65.73	$88.72	$216.98
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $113.59 / $113.59 / $113.59	Professional		$113.59	$113.59	$113.59
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $21.09 / $21.09 / $21.09	Professional	26	$21.09	$21.09	$21.09
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $92.50 / $92.50 / $92.50	Professional	TC	$92.50	$92.50	$92.50