Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $82.81 / $102.56 / $151.94	Facility	26	$82.81	$102.56	$151.94
Aetna Facility/Professional Professional Modifier Low / Median / High Price $227.85 / $296.62 / $430.77	Professional		$227.85	$296.62	$430.77
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $82.81 / $100.34 / $151.94	Professional	26	$82.81	$100.34	$151.94
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $145.05 / $196.88 / $278.82	Professional	TC	$145.05	$196.88	$278.82
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $93.50 / $101.27 / $328.95	Professional		$93.50	$101.27	$328.95
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $35.97 / $71.26 / $89.41	Professional	26	$35.97	$71.26	$89.41
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $59.34 / $420.16 / $420.16	Facility	26	$59.34	$420.16	$420.16
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $165.40 / $284.36 / $1,029.75	Professional		$165.40	$284.36	$1,029.75
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $60.78 / $104.76 / $370.65	Professional	26	$60.78	$104.76	$370.65
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $104.87 / $175.54 / $774.95	Professional	TC	$104.87	$175.54	$774.95
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $41.23 / $82.88 / $119.26	Facility	26	$41.23	$82.88	$119.26
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $117.18 / $266.79 / $408.25	Professional		$117.18	$266.79	$408.25
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $41.92 / $93.87 / $119.26	Professional	26	$41.92	$93.87	$119.26
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $76.26 / $172.92 / $312.77	Professional	TC	$76.26	$172.92	$312.77
Molina Facility/Professional Professional Modifier Low / Median / High Price $21.66 / $108.71 / $285.94	Professional		$21.66	$108.71	$285.94
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $61.25 / $83.75 / $89.11	Facility	26	$61.25	$83.75	$89.11
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $50.25 / $73.80 / $93.13	Professional	26	$50.25	$73.80	$93.13
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $89.65 / $133.80 / $220.00	Professional	TC	$89.65	$133.80	$220.00
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $59.34 / $59.34 / $60.78	Facility	26	$59.34	$59.34	$60.78
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $186.10 / $274.68 / $328.76	Professional		$186.10	$274.68	$328.76
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $68.31 / $101.39 / $121.68	Professional	26	$68.31	$101.39	$121.68
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $117.53 / $173.49 / $207.64	Professional	TC	$117.53	$173.49	$207.64
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $165.40 / $248.43 / $336.89	Professional		$165.40	$248.43	$336.89
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $60.52 / $91.11 / $119.46	Professional	26	$60.52	$91.11	$119.46
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $104.87 / $156.38 / $205.63	Professional	TC	$104.87	$156.38	$205.63
United Facility/Professional Professional Modifier Low / Median / High Price $105.83 / $154.93 / $322.27	Professional		$105.83	$154.93	$322.27
United Facility/Professional Professional Modifier 26 Low / Median / High Price $37.70 / $47.33 / $115.20	Professional	26	$37.70	$47.33	$115.20
United Facility/Professional Professional Modifier TC Low / Median / High Price $66.56 / $93.98 / $207.86	Professional	TC	$66.56	$93.98	$207.86
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $135.82 / $135.82 / $135.82	Professional		$135.82	$135.82	$135.82
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $48.33 / $48.33 / $48.33	Professional	26	$48.33	$48.33	$48.33
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $87.49 / $87.49 / $87.49	Professional	TC	$87.49	$87.49	$87.49