Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $63.53 / $104.27 / $185.19	Facility	26	$63.53	$104.27	$185.19
Aetna Facility/Professional Professional Modifier Low / Median / High Price $167.14 / $249.83 / $505.56	Professional		$167.14	$249.83	$505.56
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $51.28 / $63.53 / $151.31	Professional	26	$51.28	$63.53	$151.31
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $99.28 / $177.56 / $285.00	Professional	TC	$99.28	$177.56	$285.00
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $108.44 / $257.83 / $400.00	Professional		$108.44	$257.83	$400.00
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $53.43 / $96.53 / $108.23	Professional	26	$53.43	$96.53	$108.23
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $527.60 / $527.60 / $527.60	Facility	26	$527.60	$527.60	$527.60
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $196.35 / $337.74 / $1,561.56	Professional		$196.35	$337.74	$1,561.56
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $78.08 / $137.44 / $463.50	Professional	26	$78.08	$137.44	$463.50
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $118.27 / $214.04 / $1,649.00	Professional	TC	$118.27	$214.04	$1,649.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $148.65 / $291.02 / $493.73	Professional		$148.65	$291.02	$493.73
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $56.03 / $102.60 / $177.47	Professional	26	$56.03	$102.60	$177.47
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $89.54 / $183.28 / $318.19	Professional	TC	$89.54	$183.28	$318.19
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $62.59 / $127.04 / $319.91	Facility	26	$62.59	$127.04	$319.91
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $157.08 / $326.69 / $602.50	Professional		$157.08	$326.69	$602.50
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $55.49 / $119.71 / $154.35	Professional	26	$55.49	$119.71	$154.35
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $109.07 / $205.38 / $452.51	Professional	TC	$109.07	$205.38	$452.51
Molina Facility/Professional Professional Modifier Low / Median / High Price $23.90 / $110.69 / $295.97	Professional		$23.90	$110.69	$295.97
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $91.79 / $110.29 / $113.90	Facility	26	$91.79	$110.29	$113.90
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $78.25 / $86.94 / $86.94	Professional		$78.25	$86.94	$86.94
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $80.50 / $96.90 / $126.09	Professional	26	$80.50	$96.90	$126.09
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $126.50 / $169.51 / $277.50	Professional	TC	$126.50	$169.51	$277.50
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $76.31 / $76.31 / $76.56	Facility	26	$76.31	$76.31	$76.56
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $218.57 / $330.71 / $402.48	Professional		$218.57	$330.71	$402.48
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $86.30 / $131.08 / $156.53	Professional	26	$86.30	$131.08	$156.53
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $131.97 / $199.21 / $243.66	Professional	TC	$131.97	$199.21	$243.66
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 $196.35 / $290.64 / $394.13	Professional		$196.35	$290.64	$394.13
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $78.08 / $115.56 / $156.35	Professional	26	$78.08	$115.56	$156.35
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $118.27 / $175.08 / $241.08	Professional	TC	$118.27	$175.08	$241.08
United Facility/Professional Professional Modifier Low / Median / High Price $128.84 / $232.26 / $415.08	Professional		$128.84	$232.26	$415.08
United Facility/Professional Professional Modifier 26 Low / Median / High Price $51.84 / $64.86 / $159.79	Professional	26	$51.84	$64.86	$159.79
United Facility/Professional Professional Modifier TC Low / Median / High Price $77.00 / $108.71 / $248.07	Professional	TC	$77.00	$108.71	$248.07
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $156.24 / $156.24 / $156.24	Professional		$156.24	$156.24	$156.24
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $58.50 / $58.50 / $58.50	Professional	26	$58.50	$58.50	$58.50
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $97.75 / $97.75 / $97.75	Professional	TC	$97.75	$97.75	$97.75