Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $47.89 / $72.04 / $119.69	Facility	26	$47.89	$72.04	$119.69
Aetna Facility/Professional Professional Modifier Low / Median / High Price $109.14 / $171.97 / $350.27	Professional		$109.14	$171.97	$350.27
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $29.91 / $43.94 / $90.32	Professional	26	$29.91	$43.94	$90.32
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $79.23 / $115.55 / $242.44	Professional	TC	$79.23	$115.55	$242.44
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $254.79 / $254.79 / $254.79	Professional		$254.79	$254.79	$254.79
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $33.39 / $67.84 / $72.77	Professional	26	$33.39	$67.84	$72.77
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $100.00 / $190.76 / $190.76	Facility	26	$100.00	$190.76	$190.76
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $179.12 / $344.19 / $1,198.50	Professional		$179.12	$344.19	$1,198.50
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $58.21 / $99.25 / $350.18	Professional	26	$58.21	$99.25	$350.18
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $132.99 / $235.90 / $848.33	Professional	TC	$132.99	$235.90	$848.33
Cigna Facility/Professional Professional Modifier Low / Median / High Price $125.38 / $230.84 / $448.58	Professional		$125.38	$230.84	$448.58
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $36.29 / $66.25 / $127.68	Professional	26	$36.29	$66.25	$127.68
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $89.73 / $168.51 / $324.27	Professional	TC	$89.73	$168.51	$324.27
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $40.18 / $75.36 / $490.69	Facility	26	$40.18	$75.36	$490.69
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $125.16 / $257.27 / $375.21	Professional		$125.16	$257.27	$375.21
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $36.76 / $72.69 / $102.33	Professional	26	$36.76	$72.69	$102.33
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $92.93 / $184.68 / $272.12	Professional	TC	$92.93	$184.68	$272.12
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 $56.43 / $81.00 / $85.68	Facility	26	$56.43	$81.00	$85.68
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $45.90 / $59.16 / $86.51	Professional	26	$45.90	$59.16	$86.51
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $117.60 / $155.40 / $209.60	Professional	TC	$117.60	$155.40	$209.60
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $57.08 / $57.08 / $57.58	Facility	26	$57.08	$57.08	$57.58
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $208.57 / $322.76 / $394.06	Professional		$208.57	$322.76	$394.06
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $64.73 / $97.52 / $118.10	Professional	26	$64.73	$97.52	$118.10
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $147.16 / $228.84 / $276.12	Professional	TC	$147.16	$228.84	$276.12
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 $198.66 / $287.37 / $387.83	Professional		$198.66	$287.37	$387.83
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $58.21 / $86.57 / $117.67	Professional	26	$58.21	$86.57	$117.67
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $140.44 / $201.37 / $273.07	Professional	TC	$140.44	$201.37	$273.07
United Facility/Professional Professional Modifier Low / Median / High Price $128.18 / $154.83 / $402.80	Professional		$128.18	$154.83	$402.80
United Facility/Professional Professional Modifier 26 Low / Median / High Price $35.45 / $50.33 / $119.71	Professional	26	$35.45	$50.33	$119.71
United Facility/Professional Professional Modifier TC Low / Median / High Price $91.69 / $111.08 / $283.08	Professional	TC	$91.69	$111.08	$283.08
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $155.66 / $155.66 / $155.66	Professional		$155.66	$155.66	$155.66
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $44.10 / $44.10 / $44.10	Professional	26	$44.10	$44.10	$44.10
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $111.56 / $111.56 / $111.56	Professional	TC	$111.56	$111.56	$111.56