Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $28.71 / $45.09 / $73.25	Facility	26	$28.71	$45.09	$73.25
Aetna Facility/Professional Professional Modifier Low / Median / High Price $82.81 / $132.34 / $324.86	Professional		$82.81	$132.34	$324.86
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $22.87 / $28.72 / $75.59	Professional	26	$22.87	$28.72	$75.59
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $59.92 / $99.65 / $207.40	Professional	TC	$59.92	$99.65	$207.40
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $41.53 / $43.25 / $67.90	Professional	26	$41.53	$43.25	$67.90
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $100.00 / $113.54 / $113.54	Facility	26	$100.00	$113.54	$113.54
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $164.53 / $315.55 / $1,080.23	Professional		$164.53	$315.55	$1,080.23
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $35.11 / $61.51 / $208.65	Professional	26	$35.11	$61.51	$208.65
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $116.44 / $242.75 / $871.58	Professional	TC	$116.44	$242.75	$871.58
Cigna Facility/Professional Professional Modifier Low / Median / High Price $110.71 / $217.70 / $407.28	Professional		$110.71	$217.70	$407.28
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $26.43 / $46.22 / $76.01	Professional	26	$26.43	$46.22	$76.01
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $83.52 / $171.13 / $333.20	Professional	TC	$83.52	$171.13	$333.20
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $24.80 / $56.24 / $490.69	Facility	26	$24.80	$56.24	$490.69
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $115.14 / $218.54 / $341.10	Professional		$115.14	$218.54	$341.10
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $24.80 / $53.51 / $69.45	Professional	26	$24.80	$53.51	$69.45
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $90.52 / $162.38 / $279.70	Professional	TC	$90.52	$162.38	$279.70
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 $38.22 / $49.35 / $50.92	Facility	26	$38.22	$49.35	$50.92
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $30.55 / $42.75 / $53.96	Professional	26	$30.55	$42.75	$53.96
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $83.30 / $129.96 / $204.00	Professional	TC	$83.30	$129.96	$204.00
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $34.28 / $34.28 / $34.43	Facility	26	$34.28	$34.28	$34.43
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $187.20 / $294.11 / $356.05	Professional		$187.20	$294.11	$356.05
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $39.18 / $58.05 / $71.14	Professional	26	$39.18	$58.05	$71.14
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $149.33 / $232.84 / $284.64	Professional	TC	$149.33	$232.84	$284.64
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $346.39 / $346.39 / $385.75	Facility	26	$346.39	$346.39	$385.75
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $180.18 / $258.81 / $350.96	Professional		$180.18	$258.81	$350.96
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $36.47 / $51.90 / $70.38	Professional	26	$36.47	$51.90	$70.38
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $145.07 / $206.91 / $280.77	Professional	TC	$145.07	$206.91	$280.77
United Facility/Professional Professional Modifier Low / Median / High Price $95.03 / $143.76 / $350.54	Professional		$95.03	$143.76	$350.54
United Facility/Professional Professional Modifier 26 Low / Median / High Price $27.05 / $29.96 / $72.19	Professional	26	$27.05	$29.96	$72.19
United Facility/Professional Professional Modifier TC Low / Median / High Price $68.06 / $114.14 / $278.99	Professional	TC	$68.06	$114.14	$278.99
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $140.53 / $140.53 / $140.53	Professional		$140.53	$140.53	$140.53
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $26.21 / $26.21 / $26.21	Professional	26	$26.21	$26.21	$26.21
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $114.32 / $114.32 / $114.32	Professional	TC	$114.32	$114.32	$114.32