Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $50.37 / $59.35 / $90.46	Professional		$50.37	$59.35	$90.46
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $5.23 / $27.62 / $128.02	Professional	26	$5.23	$27.62	$128.02
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $29.26 / $38.14 / $61.17	Professional	TC	$29.26	$38.14	$61.17
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $33.77 / $33.77 / $40.75	Professional		$33.77	$33.77	$40.75
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $13.12 / $24.01 / $52.48	Professional	26	$13.12	$24.01	$52.48
Asuris Northwest Health Facility/Professional Facility Modifier Low / Median / High Price $173.88 / $379.47 / $379.47	Facility		$173.88	$379.47	$379.47
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $97.18 / $234.18 / $234.18	Facility	26	$97.18	$234.18	$234.18
Asuris Northwest Health Facility/Professional Facility Modifier TC Low / Median / High Price $100.79 / $186.22 / $186.22	Facility	TC	$100.79	$186.22	$186.22
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $82.98 / $152.86 / $641.00	Professional		$82.98	$152.86	$641.00
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $36.96 / $65.64 / $513.00	Professional	26	$36.96	$65.64	$513.00
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $49.48 / $98.77 / $362.18	Professional	TC	$49.48	$98.77	$362.18
Cigna Facility/Professional Professional Modifier Low / Median / High Price $35.31 / $72.91 / $101.28	Professional		$35.31	$72.91	$101.28
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $14.76 / $29.56 / $50.47	Professional	26	$14.76	$29.56	$50.47
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $20.54 / $42.85 / $58.29	Professional	TC	$20.54	$42.85	$58.29
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $66.95 / $162.19 / $255.96	Facility		$66.95	$162.19	$255.96
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $34.79 / $69.45 / $142.99	Facility	26	$34.79	$69.45	$142.99
Kaiser Permanente Facility/Professional Facility Modifier TC Low / Median / High Price $47.43 / $82.56 / $135.88	Facility	TC	$47.43	$82.56	$135.88
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $99.80 / $162.19 / $219.51	Professional		$99.80	$162.19	$219.51
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $41.75 / $68.55 / $110.47	Professional	26	$41.75	$68.55	$110.47
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $48.38 / $92.47 / $122.62	Professional	TC	$48.38	$92.47	$122.62
Molina Facility/Professional Professional Modifier Low / Median / High Price $10.79 / $63.88 / $148.14	Professional		$10.79	$63.88	$148.14
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $109.44 / $131.91 / $147.97	Facility		$109.44	$131.91	$147.97
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $43.99 / $53.15 / $81.34	Facility	26	$43.99	$53.15	$81.34
Pacific Source Facility/Professional Facility Modifier TC Low / Median / High Price $63.27 / $74.53 / $83.08	Facility	TC	$63.27	$74.53	$83.08
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $28.94 / $55.24 / $96.28	Professional	26	$28.94	$55.24	$96.28
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $41.61 / $66.93 / $79.41	Professional	TC	$41.61	$66.93	$79.41
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $92.41 / $152.86 / $182.76	Professional		$92.41	$152.86	$182.76
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $37.25 / $62.79 / $73.47	Professional	26	$37.25	$62.79	$73.47
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $56.17 / $92.58 / $109.29	Professional	TC	$56.17	$92.58	$109.29
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $90.09 / $125.37 / $165.17	Professional		$90.09	$125.37	$165.17
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $36.96 / $51.40 / $66.40	Professional	26	$36.96	$51.40	$66.40
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $53.13 / $74.97 / $95.98	Professional	TC	$53.13	$74.97	$95.98
United Facility/Professional Professional Modifier Low / Median / High Price $41.14 / $65.66 / $139.90	Professional		$41.14	$65.66	$139.90
United Facility/Professional Professional Modifier 26 Low / Median / High Price $17.32 / $17.39 / $57.79	Professional	26	$17.32	$17.39	$57.79
United Facility/Professional Professional Modifier TC Low / Median / High Price $23.82 / $33.65 / $81.00	Professional	TC	$23.82	$33.65	$81.00