Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $49.13 / $92.85 / $170.47	Facility	26	$49.13	$92.85	$170.47
Aetna Facility/Professional Professional Modifier Low / Median / High Price $95.59 / $115.83 / $236.17	Professional		$95.59	$115.83	$236.17
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $40.96 / $53.58 / $119.87	Professional	26	$40.96	$53.58	$119.87
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $46.35 / $61.86 / $114.95	Professional	TC	$46.35	$61.86	$114.95
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $74.91 / $74.91 / $74.91	Professional		$74.91	$74.91	$74.91
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $52.47 / $79.17 / $99.29	Professional	26	$52.47	$79.17	$99.29
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $66.14 / $262.14 / $657.04	Facility	26	$66.14	$262.14	$657.04
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $126.59 / $215.57 / $1,141.00	Professional		$126.59	$215.57	$1,141.00
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $67.45 / $113.88 / $493.68	Professional	26	$67.45	$113.88	$493.68
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $61.24 / $103.60 / $900.73	Professional	TC	$61.24	$103.60	$900.73
Cigna Facility/Professional Professional Modifier Low / Median / High Price $114.91 / $195.85 / $305.75	Professional		$114.91	$195.85	$305.75
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $61.04 / $99.52 / $159.07	Professional	26	$61.04	$99.52	$159.07
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $53.99 / $93.70 / $149.87	Professional	TC	$53.99	$93.70	$149.87
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $46.19 / $107.00 / $1,073.72	Facility	26	$46.19	$107.00	$1,073.72
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $91.45 / $205.86 / $295.37	Professional		$91.45	$205.86	$295.37
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $46.93 / $105.16 / $133.60	Professional	26	$46.93	$105.16	$133.60
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $44.95 / $101.57 / $162.90	Professional	TC	$44.95	$101.57	$162.90
Molina Facility/Professional Professional Modifier Low / Median / High Price $18.61 / $91.70 / $208.42	Professional		$18.61	$91.70	$208.42
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $68.11 / $93.80 / $99.83	Facility	26	$68.11	$93.80	$99.83
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $59.83 / $59.83 / $66.48	Professional		$59.83	$59.83	$66.48
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $56.28 / $79.80 / $99.73	Professional	26	$56.28	$79.80	$99.73
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $50.44 / $75.64 / $105.53	Professional	TC	$50.44	$75.64	$105.53
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $66.14 / $66.14 / $68.09	Facility	26	$66.14	$66.14	$68.09
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $143.84 / $215.73 / $257.39	Professional		$143.84	$215.73	$257.39
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $76.54 / $113.58 / $135.72	Professional	26	$76.54	$113.58	$135.72
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $67.53 / $102.15 / $121.68	Professional	TC	$67.53	$102.15	$121.68
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $657.04 / $657.04 / $1,088.88	Facility	26	$657.04	$657.04	$1,088.88
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $126.59 / $193.86 / $254.19	Professional		$126.59	$193.86	$254.19
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $67.45 / $102.07 / $133.83	Professional	26	$67.45	$102.07	$133.83
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $59.14 / $91.39 / $120.54	Professional	TC	$59.14	$91.39	$120.54
United Facility/Professional Professional Modifier Low / Median / High Price $115.89 / $131.32 / $255.27	Professional		$115.89	$131.32	$255.27
United Facility/Professional Professional Modifier 26 Low / Median / High Price $56.85 / $65.41 / $129.06	Professional	26	$56.85	$65.41	$129.06
United Facility/Professional Professional Modifier TC Low / Median / High Price $53.29 / $64.12 / $124.44	Professional	TC	$53.29	$64.12	$124.44
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $106.83 / $106.83 / $106.83	Professional		$106.83	$106.83	$106.83
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $53.67 / $53.67 / $53.67	Professional	26	$53.67	$53.67	$53.67
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $53.16 / $53.16 / $53.16	Professional	TC	$53.16	$53.16	$53.16