Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $53.32 / $61.86 / $138.43	Facility	26	$53.32	$61.86	$138.43
Aetna Facility/Professional Professional Modifier Low / Median / High Price $130.55 / $204.25 / $598.84	Professional		$130.55	$204.25	$598.84
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $42.60 / $63.59 / $178.04	Professional	26	$42.60	$63.59	$178.04
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $87.95 / $114.59 / $250.20	Professional	TC	$87.95	$114.59	$250.20
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $113.66 / $205.55 / $286.25	Professional		$113.66	$205.55	$286.25
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $46.07 / $76.02 / $85.23	Professional	26	$46.07	$76.02	$85.23
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $87.65 / $140.24 / $205.52	Professional	TC	$87.65	$140.24	$205.52
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $107.00 / $213.45 / $213.45	Facility	26	$107.00	$213.45	$213.45
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $187.11 / $344.32 / $1,167.15	Professional		$187.11	$344.32	$1,167.15
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $65.37 / $117.52 / $387.45	Professional	26	$65.37	$117.52	$387.45
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $122.43 / $223.67 / $779.70	Professional	TC	$122.43	$223.67	$779.70
Cigna Facility/Professional Professional Modifier Low / Median / High Price $154.19 / $251.64 / $436.94	Professional		$154.19	$251.64	$436.94
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $52.18 / $86.69 / $144.82	Professional	26	$52.18	$86.69	$144.82
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $101.46 / $166.16 / $292.26	Professional	TC	$101.46	$166.16	$292.26
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $47.12 / $101.23 / $170.73	Facility	26	$47.12	$101.23	$170.73
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $140.12 / $287.52 / $379.88	Professional		$140.12	$287.52	$379.88
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $47.12 / $100.44 / $126.79	Professional	26	$47.12	$100.44	$126.79
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $94.24 / $190.92 / $264.52	Professional	TC	$94.24	$190.92	$264.52
Molina Facility/Professional Professional Modifier Low / Median / High Price $28.94 / $143.84 / $310.91	Professional		$28.94	$143.84	$310.91
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $77.00 / $93.16 / $96.48	Facility	26	$77.00	$93.16	$96.48
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $56.28 / $80.66 / $103.66	Professional	26	$56.28	$80.66	$103.66
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $109.75 / $149.21 / $188.64	Professional	TC	$109.75	$149.21	$188.64
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $63.42 / $63.42 / $63.98	Facility	26	$63.42	$63.42	$63.98
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $210.32 / $310.45 / $381.48	Professional		$210.32	$310.45	$381.48
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $72.69 / $107.29 / $131.22	Professional	26	$72.69	$107.29	$131.22
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $137.63 / $203.53 / $250.26	Professional	TC	$137.63	$203.53	$250.26
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 $187.11 / $270.14 / $365.29	Professional		$187.11	$270.14	$365.29
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $64.68 / $93.45 / $125.75	Professional	26	$64.68	$93.45	$125.75
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $122.43 / $177.10 / $239.82	Professional	TC	$122.43	$177.10	$239.82
United Facility/Professional Professional Modifier Low / Median / High Price $142.55 / $152.49 / $371.97	Professional		$142.55	$152.49	$371.97
United Facility/Professional Professional Modifier 26 Low / Median / High Price $49.41 / $54.88 / $128.55	Professional	26	$49.41	$54.88	$128.55
United Facility/Professional Professional Modifier TC Low / Median / High Price $91.66 / $100.83 / $250.16	Professional	TC	$91.66	$100.83	$250.16
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $152.26 / $152.26 / $152.26	Professional		$152.26	$152.26	$152.26
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $49.50 / $49.50 / $49.50	Professional	26	$49.50	$49.50	$49.50
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $102.76 / $102.76 / $102.76	Professional	TC	$102.76	$102.76	$102.76