Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $38.86 / $73.40 / $133.94	Facility	26	$38.86	$73.40	$133.94
Aetna Facility/Professional Professional Modifier Low / Median / High Price $52.52 / $140.47 / $254.26	Professional		$52.52	$140.47	$254.26
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $36.49 / $40.58 / $75.52	Professional	26	$36.49	$40.58	$75.52
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $16.03 / $99.07 / $183.00	Professional	TC	$16.03	$99.07	$183.00
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $122.41 / $122.41 / $150.87	Professional		$122.41	$122.41	$150.87
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $33.44 / $33.44 / $33.44	Professional	26	$33.44	$33.44	$33.44
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $52.55 / $196.24 / $246.13	Facility	26	$52.55	$196.24	$246.13
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $189.88 / $324.52 / $1,182.38	Professional		$189.88	$324.52	$1,182.38
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $53.59 / $90.56 / $414.43	Professional	26	$53.59	$90.56	$414.43
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $136.29 / $232.73 / $857.03	Professional	TC	$136.29	$232.73	$857.03
Cigna Facility/Professional Professional Modifier Low / Median / High Price $117.86 / $264.67 / $444.99	Professional		$117.86	$264.67	$444.99
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $48.38 / $79.41 / $124.93	Professional	26	$48.38	$79.41	$124.93
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $70.64 / $190.71 / $322.12	Professional	TC	$70.64	$190.71	$322.12
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $37.82 / $89.44 / $399.23	Facility	26	$37.82	$89.44	$399.23
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $96.10 / $184.84 / $366.11	Professional		$96.10	$184.84	$366.11
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $37.82 / $84.94 / $105.81	Professional	26	$37.82	$84.94	$105.81
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $52.70 / $111.82 / $268.33	Professional	TC	$52.70	$111.82	$268.33
Molina Facility/Professional Professional Modifier Low / Median / High Price $28.80 / $146.75 / $302.27	Professional		$28.80	$146.75	$302.27
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $60.27 / $75.70 / $78.88	Facility	26	$60.27	$75.70	$78.88
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $86.08 / $86.08 / $86.08	Professional		$86.08	$86.08	$86.08
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $50.16 / $70.76 / $81.73	Professional	26	$50.16	$70.76	$81.73
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $15.08 / $33.43 / $161.69	Professional	TC	$15.08	$33.43	$161.69
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $52.55 / $52.55 / $53.47	Facility	26	$52.55	$52.55	$53.47
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $207.84 / $313.31 / $375.21	Professional		$207.84	$313.31	$375.21
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $60.83 / $89.19 / $107.46	Professional	26	$60.83	$89.19	$107.46
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $148.68 / $224.12 / $267.75	Professional	TC	$148.68	$224.12	$267.75
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 $189.88 / $274.67 / $369.16	Professional		$189.88	$274.67	$369.16
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $53.59 / $80.95 / $105.09	Professional	26	$53.59	$80.95	$105.09
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $136.29 / $198.68 / $264.07	Professional	TC	$136.29	$198.68	$264.07
United Facility/Professional Professional Modifier Low / Median / High Price $87.01 / $153.84 / $342.51	Professional		$87.01	$153.84	$342.51
United Facility/Professional Professional Modifier 26 Low / Median / High Price $46.74 / $52.75 / $102.22	Professional	26	$46.74	$52.75	$102.22
United Facility/Professional Professional Modifier TC Low / Median / High Price $34.26 / $102.86 / $254.67	Professional	TC	$34.26	$102.86	$254.67
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $157.41 / $157.41 / $157.41	Professional		$157.41	$157.41	$157.41
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $42.71 / $42.71 / $42.71	Professional	26	$42.71	$42.71	$42.71
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $114.72 / $114.72 / $114.72	Professional	TC	$114.72	$114.72	$114.72