Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $54.93 / $78.06 / $211.92	Professional		$54.93	$78.06	$211.92
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $20.09 / $47.48 / $129.41	Professional	26	$20.09	$47.48	$129.41
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $44.43 / $96.59 / $181.50	Professional	TC	$44.43	$96.59	$181.50
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $55.94 / $95.11 / $223.78	Professional		$55.94	$95.11	$223.78
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $13.59 / $43.49 / $50.50	Professional	26	$13.59	$43.49	$50.50
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $43.32 / $43.32 / $86.64	Professional	TC	$43.32	$43.32	$86.64
Asuris Northwest Health Facility/Professional Facility Modifier Low / Median / High Price $274.05 / $507.12 / $507.12	Facility		$274.05	$507.12	$507.12
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $100.00 / $116.58 / $116.58	Facility	26	$100.00	$116.58	$116.58
Asuris Northwest Health Facility/Professional Facility Modifier TC Low / Median / High Price $211.35 / $390.55 / $390.55	Facility	TC	$211.35	$390.55	$390.55
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $139.87 / $267.88 / $972.75	Professional		$139.87	$267.88	$972.75
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $35.11 / $63.91 / $211.73	Professional	26	$35.11	$63.91	$211.73
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $78.16 / $205.28 / $761.03	Professional	TC	$78.16	$205.28	$761.03
Cigna Facility/Professional Professional Modifier Low / Median / High Price $49.25 / $116.26 / $147.22	Professional		$49.25	$116.26	$147.22
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $13.98 / $28.02 / $38.92	Professional	26	$13.98	$28.02	$38.92
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $34.90 / $90.28 / $116.46	Professional	TC	$34.90	$90.28	$116.46
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $91.56 / $182.86 / $298.64	Facility		$91.56	$182.86	$298.64
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $26.02 / $52.84 / $80.51	Facility	26	$26.02	$52.84	$80.51
Kaiser Permanente Facility/Professional Facility Modifier TC Low / Median / High Price $65.54 / $131.56 / $227.23	Facility	TC	$65.54	$131.56	$227.23
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $95.79 / $196.47 / $299.73	Professional		$95.79	$196.47	$299.73
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $29.88 / $52.84 / $75.66	Professional	26	$29.88	$52.84	$75.66
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $70.37 / $142.94 / $235.73	Professional	TC	$70.37	$142.94	$235.73
Molina Facility/Professional Professional Modifier Low / Median / High Price $27.85 / $138.25 / $315.18	Professional		$27.85	$138.25	$315.18
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $135.84 / $198.99 / $226.46	Facility		$135.84	$198.99	$226.46
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $38.28 / $51.14 / $52.36	Facility	26	$38.28	$51.14	$52.36
Pacific Source Facility/Professional Facility Modifier TC Low / Median / High Price $113.43 / $147.40 / $174.87	Facility	TC	$113.43	$147.40	$174.87
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $33.18 / $48.19 / $64.87	Professional	26	$33.18	$48.19	$64.87
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $90.74 / $121.39 / $208.10	Professional	TC	$90.74	$121.39	$208.10
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $153.11 / $254.31 / $307.66	Professional		$153.11	$254.31	$307.66
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $35.95 / $60.44 / $70.72	Professional	26	$35.95	$60.44	$70.72
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $118.23 / $195.57 / $236.95	Professional	TC	$118.23	$195.57	$236.95
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $152.91 / $209.51 / $267.88	Professional		$152.91	$209.51	$267.88
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $35.11 / $48.51 / $63.66	Professional	26	$35.11	$48.51	$63.66
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $111.15 / $162.54 / $204.22	Professional	TC	$111.15	$162.54	$204.22
United Facility/Professional Professional Modifier Low / Median / High Price $64.31 / $68.11 / $241.97	Professional		$64.31	$68.11	$241.97
United Facility/Professional Professional Modifier 26 Low / Median / High Price $15.65 / $17.97 / $55.61	Professional	26	$15.65	$17.97	$55.61
United Facility/Professional Professional Modifier TC Low / Median / High Price $47.64 / $73.38 / $183.81	Professional	TC	$47.64	$73.38	$183.81