Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $45.03 / $94.97 / $155.66	Facility	26	$45.03	$94.97	$155.66
Aetna Facility/Professional Professional Modifier Low / Median / High Price $55.57 / $67.65 / $151.47	Professional		$55.57	$67.65	$151.47
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $37.99 / $47.94 / $101.47	Professional	26	$37.99	$47.94	$101.47
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $17.57 / $21.53 / $41.23	Professional	TC	$17.57	$21.53	$41.23
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $55.22 / $55.22 / $55.22	Professional		$55.22	$55.22	$55.22
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $36.42 / $45.52 / $49.40	Professional	26	$36.42	$45.52	$49.40
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $60.70 / $210.41 / $246.13	Facility	26	$60.70	$210.41	$246.13
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $87.32 / $152.78 / $551.85	Professional		$87.32	$152.78	$551.85
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $61.91 / $104.46 / $402.86	Professional	26	$61.91	$104.46	$402.86
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $25.41 / $43.88 / $402.86	Professional	TC	$25.41	$43.88	$402.86
Cigna Facility/Professional Professional Modifier Low / Median / High Price $79.62 / $130.46 / $202.76	Professional		$79.62	$130.46	$202.76
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $56.20 / $90.75 / $146.19	Professional	26	$56.20	$90.75	$146.19
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $23.42 / $40.27 / $63.35	Professional	TC	$23.42	$40.27	$63.35
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $42.47 / $97.94 / $399.23	Facility	26	$42.47	$97.94	$399.23
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $61.69 / $135.11 / $178.44	Professional		$61.69	$135.11	$178.44
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $42.86 / $96.69 / $122.84	Professional	26	$42.86	$96.69	$122.84
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $19.53 / $41.15 / $56.49	Professional	TC	$19.53	$41.15	$56.49
Molina Facility/Professional Professional Modifier Low / Median / High Price $12.75 / $64.23 / $144.49	Professional		$12.75	$64.23	$144.49
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $63.21 / $85.76 / $91.79	Facility	26	$63.21	$85.76	$91.79
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $25.79 / $25.79 / $28.65	Professional		$25.79	$25.79	$28.65
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $50.65 / $72.90 / $91.72	Professional	26	$50.65	$72.90	$91.72
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $22.11 / $31.20 / $38.09	Professional	TC	$22.11	$31.20	$38.09
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $60.70 / $60.70 / $62.61	Facility	26	$60.70	$60.70	$62.61
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $99.14 / $148.65 / $176.90	Professional		$99.14	$148.65	$176.90
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $69.86 / $104.44 / $124.49	Professional	26	$69.86	$104.44	$124.49
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $29.33 / $44.21 / $52.61	Professional	TC	$29.33	$44.21	$52.61
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $246.13 / $246.13 / $422.45	Facility	26	$246.13	$246.13	$422.45
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $87.32 / $133.58 / $175.15	Professional		$87.32	$133.58	$175.15
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $61.91 / $93.85 / $123.05	Professional	26	$61.91	$93.85	$123.05
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $25.41 / $39.22 / $52.10	Professional	TC	$25.41	$39.22	$52.10
United Facility/Professional Professional Modifier Low / Median / High Price $76.75 / $83.00 / $174.10	Professional		$76.75	$83.00	$174.10
United Facility/Professional Professional Modifier 26 Low / Median / High Price $53.61 / $59.10 / $117.81	Professional	26	$53.61	$59.10	$117.81
United Facility/Professional Professional Modifier TC Low / Median / High Price $23.17 / $25.11 / $49.36	Professional	TC	$23.17	$25.11	$49.36
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $72.17 / $72.17 / $72.17	Professional		$72.17	$72.17	$72.17
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $49.40 / $49.40 / $49.40	Professional	26	$49.40	$49.40	$49.40
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $22.77 / $22.77 / $22.77	Professional	TC	$22.77	$22.77	$22.77