Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $36.19 / $70.68 / $115.37	Facility	26	$36.19	$70.68	$115.37
Aetna Facility/Professional Professional Modifier Low / Median / High Price $118.48 / $176.99 / $404.20	Professional		$118.48	$176.99	$404.20
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $30.53 / $42.89 / $123.76	Professional	26	$30.53	$42.89	$123.76
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $87.95 / $132.86 / $241.80	Professional	TC	$87.95	$132.86	$241.80
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $170.00 / $222.88 / $301.58	Professional		$170.00	$222.88	$301.58
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $30.45 / $55.61 / $62.35	Professional	26	$30.45	$55.61	$62.35
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $76.68 / $147.81 / $166.89	Facility	26	$76.68	$147.81	$166.89
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $239.94 / $502.60 / $1,197.23	Professional		$239.94	$502.60	$1,197.23
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $43.89 / $75.36 / $371.50	Professional	26	$43.89	$75.36	$371.50
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $164.63 / $403.00 / $932.78	Professional	TC	$164.63	$403.00	$932.78
Cigna Facility/Professional Professional Modifier Low / Median / High Price $127.12 / $317.58 / $641.09	Professional		$127.12	$317.58	$641.09
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $35.28 / $59.66 / $98.44	Professional	26	$35.28	$59.66	$98.44
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $83.08 / $257.13 / $542.64	Professional	TC	$83.08	$257.13	$542.64
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $32.22 / $68.48 / $113.44	Facility	26	$32.22	$68.48	$113.44
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $94.86 / $193.20 / $502.28	Professional		$94.86	$193.20	$502.28
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $31.60 / $66.95 / $87.30	Professional	26	$31.60	$66.95	$87.30
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $56.11 / $127.46 / $429.93	Professional	TC	$56.11	$127.46	$429.93
Molina Facility/Professional Professional Modifier Low / Median / High Price $29.15 / $151.38 / $373.59	Professional		$29.15	$151.38	$373.59
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $50.96 / $63.61 / $64.98	Facility	26	$50.96	$63.61	$64.98
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $105.65 / $105.65 / $105.65	Professional		$105.65	$105.65	$105.65
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $44.23 / $55.57 / $67.45	Professional	26	$44.23	$55.57	$67.45
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $75.25 / $143.08 / $299.32	Professional	TC	$75.25	$143.08	$299.32
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $43.04 / $43.04 / $43.87	Facility	26	$43.04	$43.04	$43.87
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $296.62 / $458.82 / $566.13	Professional		$296.62	$458.82	$566.13
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $49.04 / $73.18 / $89.98	Professional	26	$49.04	$73.18	$89.98
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $249.89 / $386.54 / $476.15	Professional	TC	$249.89	$386.54	$476.15
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 $282.27 / $397.07 / $534.84	Professional		$282.27	$397.07	$534.84
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $43.89 / $63.18 / $86.23	Professional	26	$43.89	$63.18	$86.23
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $238.39 / $333.96 / $449.83	Professional	TC	$238.39	$333.96	$449.83
United Facility/Professional Professional Modifier Low / Median / High Price $128.38 / $177.20 / $503.05	Professional		$128.38	$177.20	$503.05
United Facility/Professional Professional Modifier 26 Low / Median / High Price $34.01 / $37.72 / $86.61	Professional	26	$34.01	$37.72	$86.61
United Facility/Professional Professional Modifier TC Low / Median / High Price $88.79 / $138.15 / $422.30	Professional	TC	$88.79	$138.15	$422.30
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $163.02 / $163.02 / $163.02	Professional		$163.02	$163.02	$163.02
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $33.70 / $33.70 / $33.70	Professional	26	$33.70	$33.70	$33.70
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $129.32 / $129.32 / $129.32	Professional	TC	$129.32	$129.32	$129.32