Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $104.98 / $197.93 / $363.83	Facility	26	$104.98	$197.93	$363.83
Aetna Facility/Professional Professional Modifier Low / Median / High Price $133.35 / $206.78 / $406.52	Professional		$133.35	$206.78	$406.52
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $90.92 / $127.73 / $289.18	Professional	26	$90.92	$127.73	$289.18
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $28.37 / $88.89 / $163.22	Professional	TC	$28.37	$88.89	$163.22
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $129.49 / $129.49 / $129.49	Professional		$129.49	$129.49	$129.49
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $84.70 / $91.91 / $211.76	Professional	26	$84.70	$91.91	$211.76
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $141.79 / $722.52 / $1,052.55	Facility	26	$141.79	$722.52	$1,052.55
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $183.88 / $319.14 / $3,014.42	Professional		$183.88	$319.14	$3,014.42
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $145.33 / $251.73 / $1,056.82	Professional	26	$145.33	$251.73	$1,056.82
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $47.71 / $76.79 / $2,488.46	Professional	TC	$47.71	$76.79	$2,488.46
Cigna Facility/Professional Professional Modifier Low / Median / High Price $173.80 / $280.62 / $457.29	Professional		$173.80	$280.62	$457.29
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $130.80 / $215.35 / $339.37	Professional	26	$130.80	$215.35	$339.37
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $40.11 / $69.81 / $119.80	Professional	TC	$40.11	$69.81	$119.80
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $98.58 / $235.40 / $1,713.52	Facility	26	$98.58	$235.40	$1,713.52
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $138.26 / $298.45 / $479.10	Professional		$138.26	$298.45	$479.10
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $99.81 / $228.65 / $285.14	Professional	26	$99.81	$228.65	$285.14
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $38.19 / $74.47 / $220.55	Professional	TC	$38.19	$74.47	$220.55
Molina Facility/Professional Professional Modifier Low / Median / High Price $26.31 / $118.38 / $288.99	Professional		$26.31	$118.38	$288.99
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $149.44 / $200.33 / $213.06	Facility	26	$149.44	$200.33	$213.06
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $34.54 / $34.54 / $34.54	Professional		$34.54	$34.54	$34.54
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $137.09 / $182.04 / $231.04	Professional	26	$137.09	$182.04	$231.04
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $45.83 / $73.70 / $212.16	Professional	TC	$45.83	$73.70	$212.16
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $141.79 / $141.79 / $145.33	Facility	26	$141.79	$141.79	$145.33
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $213.93 / $324.74 / $386.42	Professional		$213.93	$324.74	$386.42
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $163.92 / $242.41 / $290.16	Professional	26	$163.92	$242.41	$290.16
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $50.80 / $76.41 / $97.97	Professional	TC	$50.80	$76.41	$97.97
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $1,052.55 / $1,052.55 / $1,760.29	Facility	26	$1,052.55	$1,052.55	$1,760.29
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $183.88 / $281.37 / $382.63	Professional		$183.88	$281.37	$382.63
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $144.61 / $217.83 / $285.63	Professional	26	$144.61	$217.83	$285.63
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $39.27 / $69.15 / $92.77	Professional	TC	$39.27	$69.15	$92.77
United Facility/Professional Professional Modifier Low / Median / High Price $170.15 / $216.99 / $446.32	Professional		$170.15	$216.99	$446.32
United Facility/Professional Professional Modifier 26 Low / Median / High Price $127.02 / $138.50 / $275.45	Professional	26	$127.02	$138.50	$275.45
United Facility/Professional Professional Modifier TC Low / Median / High Price $32.47 / $45.47 / $151.36	Professional	TC	$32.47	$45.47	$151.36
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $160.83 / $160.83 / $160.83	Professional		$160.83	$160.83	$160.83
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $114.89 / $114.89 / $114.89	Professional	26	$114.89	$114.89	$114.89
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $45.93 / $45.93 / $45.93	Professional	TC	$45.93	$45.93	$45.93