Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $53.54 / $65.43 / $129.68	Facility	26	$53.54	$65.43	$129.68
Aetna Facility/Professional Professional Modifier Low / Median / High Price $151.74 / $195.76 / $504.90	Professional		$151.74	$195.76	$504.90
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $42.89 / $53.55 / $123.75	Professional	26	$42.89	$53.55	$123.75
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $240.30 / $240.30 / $240.30	Professional	52	$240.30	$240.30	$240.30
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $103.12 / $136.50 / $284.42	Professional	TC	$103.12	$136.50	$284.42
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $153.86 / $298.67 / $432.83	Professional		$153.86	$298.67	$432.83
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $37.01 / $75.44 / $90.74	Professional	26	$37.01	$75.44	$90.74
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $98.65 / $211.96 / $211.96	Facility	26	$98.65	$211.96	$211.96
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $217.53 / $375.22 / $1,368.98	Professional		$217.53	$375.22	$1,368.98
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $65.14 / $112.28 / $388.43	Professional	26	$65.14	$112.28	$388.43
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $154.31 / $264.39 / $980.55	Professional	TC	$154.31	$264.39	$980.55
Cigna Facility/Professional Professional Modifier Low / Median / High Price $174.45 / $297.83 / $512.44	Professional		$174.45	$297.83	$512.44
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $49.72 / $86.30 / $142.00	Professional	26	$49.72	$86.30	$142.00
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $122.03 / $212.29 / $374.14	Professional	TC	$122.03	$212.29	$374.14
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $46.81 / $105.35 / $141.56	Facility	26	$46.81	$105.35	$141.56
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $167.71 / $342.94 / $452.27	Professional		$167.71	$342.94	$452.27
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $46.81 / $100.70 / $129.47	Professional	26	$46.81	$100.70	$129.47
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $127.02 / $259.99 / $345.57	Professional	TC	$127.02	$259.99	$345.57
Molina Facility/Professional Professional Modifier Low / Median / High Price $31.46 / $154.66 / $374.57	Professional		$31.46	$154.66	$374.57
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $76.95 / $92.51 / $95.14	Facility	26	$76.95	$92.51	$95.14
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $57.20 / $77.00 / $93.80	Professional	26	$57.20	$77.00	$93.80
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $156.21 / $184.80 / $227.13	Professional	TC	$156.21	$184.80	$227.13
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $63.87 / $63.87 / $63.98	Facility	26	$63.87	$63.87	$63.98
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $244.68 / $368.42 / $451.15	Professional		$244.68	$368.42	$451.15
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $72.27 / $110.10 / $133.28	Professional	26	$72.27	$110.10	$133.28
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $172.41 / $260.06 / $317.89	Professional	TC	$172.41	$260.06	$317.89
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $226.77 / $226.77 / $311.07	Facility	26	$226.77	$226.77	$311.07
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $219.45 / $326.80 / $445.13	Professional		$219.45	$326.80	$445.13
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $65.41 / $96.88 / $131.52	Professional	26	$65.41	$96.88	$131.52
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $156.97 / $230.18 / $313.62	Professional	TC	$156.97	$230.18	$313.62
United Facility/Professional Professional Modifier Low / Median / High Price $176.69 / $205.69 / $450.31	Professional		$176.69	$205.69	$450.31
United Facility/Professional Professional Modifier 26 Low / Median / High Price $52.18 / $59.30 / $132.99	Professional	26	$52.18	$59.30	$132.99
United Facility/Professional Professional Modifier TC Low / Median / High Price $131.74 / $149.47 / $317.32	Professional	TC	$131.74	$149.47	$317.32
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $181.01 / $181.01 / $181.01	Professional		$181.01	$181.01	$181.01
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $49.05 / $49.05 / $49.05	Professional	26	$49.05	$49.05	$49.05
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $131.96 / $131.96 / $131.96	Professional	TC	$131.96	$131.96	$131.96