Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $42.92 / $67.40 / $119.69	Facility	26	$42.92	$67.40	$119.69
Aetna Facility/Professional Professional Modifier Low / Median / High Price $101.04 / $131.28 / $310.86	Professional		$101.04	$131.28	$310.86
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $29.91 / $42.93 / $97.85	Professional	26	$29.91	$42.93	$97.85
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $71.14 / $92.23 / $209.98	Professional	TC	$71.14	$92.23	$209.98
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $21.20 / $63.89 / $66.94	Professional	26	$21.20	$63.89	$66.94
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $100.00 / $172.60 / $172.60	Facility	26	$100.00	$172.60	$172.60
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $168.18 / $302.04 / $1,057.20	Professional		$168.18	$302.04	$1,057.20
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $52.21 / $90.44 / $313.64	Professional	26	$52.21	$90.44	$313.64
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $105.26 / $204.80 / $743.55	Professional	TC	$105.26	$204.80	$743.55
Cigna Facility/Professional Professional Modifier Low / Median / High Price $110.77 / $203.74 / $395.88	Professional		$110.77	$203.74	$395.88
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $35.81 / $63.36 / $114.65	Professional	26	$35.81	$63.36	$114.65
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $76.48 / $142.36 / $284.12	Professional	TC	$76.48	$142.36	$284.12
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $40.59 / $75.76 / $490.69	Facility	26	$40.59	$75.76	$490.69
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $111.39 / $228.32 / $330.48	Professional		$111.39	$228.32	$330.48
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $36.45 / $72.78 / $97.75	Professional	26	$36.45	$72.78	$97.75
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $78.84 / $156.06 / $237.25	Professional	TC	$78.84	$156.06	$237.25
Molina Facility/Professional Professional Modifier Low / Median / High Price $23.90 / $110.49 / $296.23	Professional		$23.90	$110.49	$296.23
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $56.43 / $73.09 / $76.84	Facility	26	$56.43	$73.09	$76.84
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $119.19 / $119.19 / $132.44	Professional		$119.19	$119.19	$132.44
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $39.79 / $59.40 / $77.59	Professional	26	$39.79	$59.40	$77.59
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $95.52 / $135.11 / $171.01	Professional	TC	$95.52	$135.11	$171.01
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $51.19 / $51.19 / $51.64	Facility	26	$51.19	$51.19	$51.64
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $186.10 / $288.06 / $344.93	Professional		$186.10	$288.06	$344.93
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $57.14 / $87.46 / $107.58	Professional	26	$57.14	$87.46	$107.58
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $128.94 / $197.83 / $239.01	Professional	TC	$128.94	$197.83	$239.01
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $346.39 / $346.39 / $851.78	Facility	26	$346.39	$346.39	$851.78
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $174.17 / $252.08 / $340.03	Professional		$174.17	$252.08	$340.03
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $53.00 / $77.64 / $106.04	Professional	26	$53.00	$77.64	$106.04
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $121.97 / $176.43 / $239.29	Professional	TC	$121.97	$176.43	$239.29
United Facility/Professional Professional Modifier Low / Median / High Price $106.40 / $134.57 / $335.01	Professional		$106.40	$134.57	$335.01
United Facility/Professional Professional Modifier 26 Low / Median / High Price $35.45 / $45.13 / $108.30	Professional	26	$35.45	$45.13	$108.30
United Facility/Professional Professional Modifier TC Low / Median / High Price $76.69 / $92.00 / $225.22	Professional	TC	$76.69	$92.00	$225.22
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $137.68 / $137.68 / $137.68	Professional		$137.68	$137.68	$137.68
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $39.93 / $39.93 / $39.93	Professional	26	$39.93	$39.93	$39.93
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $97.75 / $97.75 / $97.75	Professional	TC	$97.75	$97.75	$97.75