Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $30.36 / $57.74 / $94.44	Facility	26	$30.36	$57.74	$94.44
Aetna Facility/Professional Professional Modifier Low / Median / High Price $97.57 / $141.49 / $279.94	Professional		$97.57	$141.49	$279.94
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $23.32 / $30.36 / $63.86	Professional	26	$23.32	$30.36	$63.86
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $73.93 / $117.88 / $217.00	Professional	TC	$73.93	$117.88	$217.00
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $145.72 / $145.72 / $145.72	Professional	TC	$145.72	$145.72	$145.72
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $100.00 / $121.12 / $121.12	Facility	26	$100.00	$121.12	$121.12
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $178.12 / $317.49 / $1,141.13	Professional		$178.12	$317.49	$1,141.13
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $36.96 / $64.87 / $220.05	Professional	26	$36.96	$64.87	$220.05
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $138.88 / $248.91 / $921.08	Professional	TC	$138.88	$248.91	$921.08
Cigna Facility/Professional Professional Modifier Low / Median / High Price $114.18 / $207.69 / $430.23	Professional		$114.18	$207.69	$430.23
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $27.13 / $47.87 / $80.17	Professional	26	$27.13	$47.87	$80.17
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $87.09 / $165.60 / $338.67	Professional	TC	$87.09	$165.60	$338.67
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $25.42 / $57.72 / $1,002.46	Facility	26	$25.42	$57.72	$1,002.46
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $100.13 / $214.57 / $347.02	Professional		$100.13	$214.57	$347.02
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $25.42 / $54.92 / $73.52	Professional	26	$25.42	$54.92	$73.52
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $75.95 / $160.71 / $278.93	Professional	TC	$75.95	$160.71	$278.93
Molina Facility/Professional Professional Modifier Low / Median / High Price $29.31 / $148.77 / $312.97	Professional		$29.31	$148.77	$312.97
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $43.45 / $52.26 / $52.93	Facility	26	$43.45	$52.26	$52.93
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $35.19 / $45.60 / $55.77	Professional	26	$35.19	$45.60	$55.77
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $95.88 / $132.60 / $186.21	Professional	TC	$95.88	$132.60	$186.21
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $36.10 / $36.10 / $36.24	Facility	26	$36.10	$36.10	$36.24
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $198.34 / $301.39 / $370.23	Professional		$198.34	$301.39	$370.23
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $41.30 / $62.13 / $75.20	Professional	26	$41.30	$62.13	$75.20
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $155.44 / $240.89 / $296.19	Professional	TC	$155.44	$240.89	$296.19
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $714.15 / $714.15 / $1,538.06	Facility	26	$714.15	$714.15	$1,538.06
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $183.88 / $263.85 / $358.97	Professional		$183.88	$263.85	$358.97
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $38.40 / $54.67 / $74.13	Professional	26	$38.40	$54.67	$74.13
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $146.91 / $212.52 / $295.11	Professional	TC	$146.91	$212.52	$295.11
United Facility/Professional Professional Modifier Low / Median / High Price $106.72 / $134.57 / $376.19	Professional		$106.72	$134.57	$376.19
United Facility/Professional Professional Modifier 26 Low / Median / High Price $27.93 / $30.97 / $73.08	Professional	26	$27.93	$30.97	$73.08
United Facility/Professional Professional Modifier TC Low / Median / High Price $83.39 / $117.79 / $273.70	Professional	TC	$83.39	$117.79	$273.70
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $149.55 / $149.55 / $149.55	Professional		$149.55	$149.55	$149.55
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $28.12 / $28.12 / $28.12	Professional	26	$28.12	$28.12	$28.12
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $121.43 / $121.43 / $121.43	Professional	TC	$121.43	$121.43	$121.43