Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $67.31 / $286.08 / $1,505.36	Facility		$67.31	$286.08	$1,505.36
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $33.88 / $53.92 / $98.90	Facility	26	$33.88	$53.92	$98.90
Aetna Facility/Professional Professional Modifier Low / Median / High Price $61.27 / $159.74 / $391.30	Professional		$61.27	$159.74	$391.30
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $29.01 / $40.78 / $124.46	Professional	26	$29.01	$40.78	$124.46
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $29.86 / $74.02 / $240.37	Professional	TC	$29.86	$74.02	$240.37
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $46.54 / $78.65 / $117.04	Professional		$46.54	$78.65	$117.04
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $24.93 / $50.11 / $58.66	Professional	26	$24.93	$50.11	$58.66
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $58.38 / $58.38 / $58.38	Professional	TC	$58.38	$58.38	$58.38
Asuris Northwest Health Facility/Professional Facility Modifier Low / Median / High Price $126.61 / $889.98 / $889.98	Facility		$126.61	$889.98	$889.98
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $72.14 / $261.98 / $261.98	Facility	26	$72.14	$261.98	$261.98
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $79.52 / $144.41 / $947.00	Professional		$79.52	$144.41	$947.00
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $41.58 / $73.81 / $368.00	Professional	26	$41.58	$73.81	$368.00
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $41.32 / $73.31 / $758.00	Professional	TC	$41.32	$73.31	$758.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $71.23 / $129.21 / $274.58	Professional		$71.23	$129.21	$274.58
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $34.47 / $56.27 / $92.65	Professional	26	$34.47	$56.27	$92.65
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $34.02 / $66.31 / $219.24	Professional	TC	$34.02	$66.31	$219.24
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $90.71 / $166.78 / $453.91	Facility		$90.71	$166.78	$453.91
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $30.07 / $64.17 / $81.84	Facility	26	$30.07	$64.17	$81.84
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $85.50 / $150.91 / $436.54	Professional		$85.50	$150.91	$436.54
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $30.35 / $64.45 / $82.01	Professional	26	$30.35	$64.45	$82.01
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $39.50 / $75.05 / $353.64	Professional	TC	$39.50	$75.05	$353.64
Molina Facility/Professional Professional Modifier Low / Median / High Price $12.62 / $65.14 / $147.70	Professional		$12.62	$65.14	$147.70
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $84.28 / $114.57 / $262.35	Facility		$84.28	$114.57	$262.35
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $48.95 / $59.39 / $61.75	Facility	26	$48.95	$59.39	$61.75
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $38.64 / $55.46 / $65.31	Professional	26	$38.64	$55.46	$65.31
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $36.02 / $53.13 / $285.56	Professional	TC	$36.02	$53.13	$285.56
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $77.92 / $77.92 / $79.52	Facility		$77.92	$77.92	$79.52
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $40.67 / $40.67 / $40.77	Facility	26	$40.67	$40.67	$40.77
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $89.70 / $132.65 / $165.61	Professional		$89.70	$132.65	$165.61
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $46.46 / $68.48 / $83.42	Professional	26	$46.46	$68.48	$83.42
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $43.30 / $64.80 / $80.92	Professional	TC	$43.30	$64.80	$80.92
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $37.88 / $37.88 / $37.88	Facility		$37.88	$37.88	$37.88
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $79.45 / $115.21 / $156.29	Professional		$79.45	$115.21	$156.29
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $41.58 / $59.86 / $79.94	Professional	26	$41.58	$59.86	$79.94
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $37.88 / $55.88 / $76.34	Professional	TC	$37.88	$55.88	$76.34
United Facility/Professional Professional Modifier Low / Median / High Price $58.47 / $79.39 / $199.83	Professional		$58.47	$79.39	$199.83
United Facility/Professional Professional Modifier 26 Low / Median / High Price $32.47 / $35.54 / $84.74	Professional	26	$32.47	$35.54	$84.74
United Facility/Professional Professional Modifier TC Low / Median / High Price $25.99 / $38.17 / $150.81	Professional	TC	$25.99	$38.17	$150.81
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $65.54 / $65.54 / $65.54	Professional		$65.54	$65.54	$65.54
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $31.32 / $31.32 / $31.32	Professional	26	$31.32	$31.32	$31.32
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $34.21 / $34.21 / $34.21	Professional	TC	$34.21	$34.21	$34.21