Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $53.54 / $84.07 / $154.60	Facility	26	$53.54	$84.07	$154.60
Aetna Facility/Professional Professional Modifier Low / Median / High Price $158.99 / $247.93 / $428.17	Professional		$158.99	$247.93	$428.17
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $44.88 / $56.90 / $133.43	Professional	26	$44.88	$56.90	$133.43
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $104.01 / $190.34 / $306.32	Professional	TC	$104.01	$190.34	$306.32
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $92.91 / $122.89 / $122.89	Professional		$92.91	$122.89	$122.89
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $44.47 / $75.44 / $126.54	Professional	26	$44.47	$75.44	$126.54
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $137.13 / $137.13 / $137.13	Professional	TC	$137.13	$137.13	$137.13
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $442.24 / $442.24 / $442.24	Facility	26	$442.24	$442.24	$442.24
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $185.72 / $321.25 / $1,609.32	Professional		$185.72	$321.25	$1,609.32
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $65.14 / $116.69 / $388.43	Professional	26	$65.14	$116.69	$388.43
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $120.58 / $219.90 / $1,318.35	Professional	TC	$120.58	$219.90	$1,318.35
Cigna Facility/Professional Professional Modifier Low / Median / High Price $144.97 / $306.56 / $489.42	Professional		$144.97	$306.56	$489.42
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $47.19 / $86.49 / $154.12	Professional	26	$47.19	$86.49	$154.12
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $95.99 / $220.13 / $368.83	Professional	TC	$95.99	$220.13	$368.83
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $52.65 / $106.12 / $319.91	Facility	26	$52.65	$106.12	$319.91
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $178.97 / $353.22 / $627.20	Professional		$178.97	$353.22	$627.20
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $47.24 / $101.68 / $141.56	Professional	26	$47.24	$101.68	$141.56
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $139.57 / $253.13 / $494.68	Professional	TC	$139.57	$253.13	$494.68
Molina Facility/Professional Professional Modifier Low / Median / High Price $29.33 / $149.27 / $312.59	Professional		$29.33	$149.27	$312.59
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $76.95 / $92.51 / $95.88	Facility	26	$76.95	$92.51	$95.88
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $57.20 / $81.91 / $108.28	Professional	26	$57.20	$81.91	$108.28
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $160.00 / $223.87 / $287.79	Professional	TC	$160.00	$223.87	$287.79
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $63.87 / $63.87 / $63.98	Facility	26	$63.87	$63.87	$63.98
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $207.23 / $314.17 / $382.82	Professional		$207.23	$314.17	$382.82
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $72.17 / $110.10 / $133.25	Professional	26	$72.17	$110.10	$133.25
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $135.06 / $206.38 / $250.85	Professional	TC	$135.06	$206.38	$250.85
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 $185.72 / $276.11 / $409.57	Professional		$185.72	$276.11	$409.57
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $65.14 / $96.88 / $131.52	Professional	26	$65.14	$96.88	$131.52
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $120.58 / $179.23 / $276.61	Professional	TC	$120.58	$179.23	$276.61
United Facility/Professional Professional Modifier Low / Median / High Price $134.36 / $242.19 / $426.64	Professional		$134.36	$242.19	$426.64
United Facility/Professional Professional Modifier 26 Low / Median / High Price $43.56 / $57.34 / $136.75	Professional	26	$43.56	$57.34	$136.75
United Facility/Professional Professional Modifier TC Low / Median / High Price $90.80 / $178.75 / $292.51	Professional	TC	$90.80	$178.75	$292.51
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $149.56 / $149.56 / $149.56	Professional		$149.56	$149.56	$149.56
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $49.05 / $49.05 / $49.05	Professional	26	$49.05	$49.05	$49.05
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $100.51 / $100.51 / $100.51	Professional	TC	$100.51	$100.51	$100.51