Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $50.89 / $88.33 / $133.00	Professional		$50.89	$88.33	$133.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $22.66 / $31.59 / $42.82	Professional	26	$22.66	$31.59	$42.82
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $24.89 / $41.31 / $55.68	Professional	52	$24.89	$41.31	$55.68
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $28.65 / $52.82 / $91.08	Professional	TC	$28.65	$52.82	$91.08
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $62.89 / $84.90 / $132.24	Professional		$62.89	$84.90	$132.24
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $52.15 / $52.15 / $52.15	Professional	26	$52.15	$52.15	$52.15
Asuris Northwest Health Facility/Professional Facility Modifier Low / Median / High Price $83.35 / $220.95 / $286.08	Facility		$83.35	$220.95	$286.08
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $35.33 / $61.29 / $152.15	Facility	26	$35.33	$61.29	$152.15
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $85.01 / $155.03 / $542.92	Professional		$85.01	$155.03	$542.92
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $35.39 / $65.84 / $218.55	Professional	26	$35.39	$65.84	$218.55
Asuris Northwest Health Facility/Professional Professional Modifier 52 Low / Median / High Price $30.23 / $30.23 / $30.23	Professional	52	$30.23	$30.23	$30.23
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $48.97 / $89.18 / $324.38	Professional	TC	$48.97	$89.18	$324.38
Cigna Facility/Professional Professional Modifier Low / Median / High Price $62.10 / $105.11 / $194.34	Professional		$62.10	$105.11	$194.34
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $24.73 / $43.49 / $79.81	Professional	26	$24.73	$43.49	$79.81
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $35.44 / $61.56 / $115.93	Professional	TC	$35.44	$61.56	$115.93
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $63.04 / $98.73 / $180.57	Facility		$63.04	$98.73	$180.57
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $26.04 / $38.49 / $69.55	Facility	26	$26.04	$38.49	$69.55
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $62.62 / $98.45 / $167.15	Professional		$62.62	$98.45	$167.15
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $25.88 / $39.47 / $68.59	Professional	26	$25.88	$39.47	$68.59
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $36.47 / $57.89 / $101.53	Professional	TC	$36.47	$57.89	$101.53
Molina Facility/Professional Professional Modifier Low / Median / High Price $10.73 / $62.91 / $149.31	Professional		$10.73	$62.91	$149.31
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $76.44 / $121.27 / $131.65	Facility		$76.44	$121.27	$131.65
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $39.69 / $52.43 / $53.04	Facility	26	$39.69	$52.43	$53.04
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $33.97 / $40.50 / $57.67	Professional	26	$33.97	$40.50	$57.67
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $46.06 / $61.05 / $80.91	Professional	TC	$46.06	$61.05	$80.91
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $83.35 / $83.35 / $83.35	Facility		$83.35	$83.35	$83.35
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $35.33 / $35.33 / $35.33	Facility	26	$35.33	$35.33	$35.33
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $96.63 / $147.06 / $172.35	Professional		$96.63	$147.06	$172.35
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $41.04 / $62.20 / $71.95	Professional	26	$41.04	$62.20	$71.95
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $55.59 / $84.70 / $100.69	Professional	TC	$55.59	$84.70	$100.69
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $85.01 / $123.15 / $156.71	Professional		$85.01	$123.15	$156.71
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $36.04 / $51.39 / $65.56	Professional	26	$36.04	$51.39	$65.56
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $48.97 / $70.84 / $91.55	Professional	TC	$48.97	$70.84	$91.55
United Facility/Professional Professional Modifier Low / Median / High Price $45.85 / $99.68 / $175.91	Professional		$45.85	$99.68	$175.91
United Facility/Professional Professional Modifier 26 Low / Median / High Price $19.16 / $40.56 / $76.27	Professional	26	$19.16	$40.56	$76.27
United Facility/Professional Professional Modifier TC Low / Median / High Price $26.69 / $58.00 / $99.00	Professional	TC	$26.69	$58.00	$99.00