Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $58.14 / $92.53 / $169.62	Facility	26	$58.14	$92.53	$169.62
Aetna Facility/Professional Professional Modifier Low / Median / High Price $163.04 / $246.41 / $415.80	Professional		$163.04	$246.41	$415.80
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $49.60 / $62.15 / $145.63	Professional	26	$49.60	$62.15	$145.63
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $100.88 / $179.64 / $305.89	Professional	TC	$100.88	$179.64	$305.89
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $105.85 / $222.12 / $222.12	Professional		$105.85	$222.12	$222.12
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $48.94 / $82.37 / $88.34	Professional	26	$48.94	$82.37	$88.34
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $482.96 / $482.96 / $482.96	Facility	26	$482.96	$482.96	$482.96
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $188.22 / $327.63 / $1,593.12	Professional		$188.22	$327.63	$1,593.12
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $70.69 / $126.17 / $425.25	Professional	26	$70.69	$126.17	$425.25
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $119.66 / $215.88 / $1,318.35	Professional	TC	$119.66	$215.88	$1,318.35
Cigna Facility/Professional Professional Modifier Low / Median / High Price $144.86 / $286.08 / $486.77	Professional		$144.86	$286.08	$486.77
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $51.17 / $93.57 / $162.47	Professional	26	$51.17	$93.57	$162.47
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $90.95 / $185.43 / $321.93	Professional	TC	$90.95	$185.43	$321.93
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $57.07 / $116.45 / $319.91	Facility	26	$57.07	$116.45	$319.91
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $157.08 / $318.36 / $596.74	Professional		$157.08	$318.36	$596.74
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $50.53 / $109.15 / $141.47	Professional	26	$50.53	$109.15	$141.47
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $110.76 / $208.21 / $458.11	Professional	TC	$110.76	$208.21	$458.11
Molina Facility/Professional Professional Modifier Low / Median / High Price $29.44 / $149.27 / $312.59	Professional		$29.44	$149.27	$312.59
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $84.09 / $100.95 / $104.52	Facility	26	$84.09	$100.95	$104.52
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $91.43 / $91.43 / $91.43	Professional		$91.43	$91.43	$91.43
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $62.40 / $87.78 / $108.24	Professional	26	$62.40	$87.78	$108.24
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $109.34 / $160.47 / $340.36	Professional	TC	$109.34	$160.47	$340.36
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $69.31 / $69.31 / $69.92	Facility	26	$69.31	$69.31	$69.92
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $212.90 / $322.05 / $392.18	Professional		$212.90	$322.05	$392.18
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $79.02 / $120.09 / $145.66	Professional	26	$79.02	$120.09	$145.66
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $133.51 / $201.57 / $248.98	Professional	TC	$133.51	$201.57	$248.98
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 $190.34 / $283.02 / $385.70	Professional		$190.34	$283.02	$385.70
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $70.69 / $105.88 / $142.55	Professional	26	$70.69	$105.88	$142.55
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $119.66 / $177.15 / $243.90	Professional	TC	$119.66	$177.15	$243.90
United Facility/Professional Professional Modifier Low / Median / High Price $125.47 / $212.69 / $404.21	Professional		$125.47	$212.69	$404.21
United Facility/Professional Professional Modifier 26 Low / Median / High Price $47.24 / $59.70 / $150.01	Professional	26	$47.24	$59.70	$150.01
United Facility/Professional Professional Modifier TC Low / Median / High Price $78.23 / $157.59 / $262.73	Professional	TC	$78.23	$157.59	$262.73
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $152.87 / $152.87 / $152.87	Professional		$152.87	$152.87	$152.87
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $53.54 / $53.54 / $53.54	Professional	26	$53.54	$53.54	$53.54
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $99.33 / $99.33 / $99.33	Professional	TC	$99.33	$99.33	$99.33