Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $51.77 / $81.70 / $105.47	Facility	26	$51.77	$81.70	$105.47
Aetna Facility/Professional Professional Modifier Low / Median / High Price $62.12 / $94.70 / $272.00	Professional		$62.12	$94.70	$272.00
Aetna Facility/Professional Professional Modifier 25 Low / Median / High Price $113.88 / $113.88 / $113.88	Professional	25	$113.88	$113.88	$113.88
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $38.03 / $51.68 / $174.00	Professional	26	$38.03	$51.68	$174.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $22.57 / $44.83 / $90.79	Professional	TC	$22.57	$44.83	$90.79
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $108.49 / $142.43 / $160.56	Professional		$108.49	$142.43	$160.56
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $43.67 / $58.56 / $70.23	Professional	26	$43.67	$58.56	$70.23
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $72.06 / $85.71 / $174.72	Facility	26	$72.06	$85.71	$174.72
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $103.32 / $179.82 / $668.33	Professional		$103.32	$179.82	$668.33
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $50.79 / $82.94 / $297.45	Professional	26	$50.79	$82.94	$297.45
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $49.84 / $96.36 / $370.95	Professional	TC	$49.84	$96.36	$370.95
Cigna Facility/Professional Professional Modifier Low / Median / High Price $69.66 / $131.28 / $269.89	Professional		$69.66	$131.28	$269.89
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $41.22 / $68.84 / $119.74	Professional	26	$41.22	$68.84	$119.74
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $24.61 / $68.39 / $150.16	Professional	TC	$24.61	$68.39	$150.16
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $34.88 / $51.84 / $103.12	Facility	26	$34.88	$51.84	$103.12
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $53.76 / $82.28 / $157.86	Professional		$53.76	$82.28	$157.86
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $34.88 / $51.33 / $94.34	Professional	26	$34.88	$51.33	$94.34
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $19.09 / $29.92 / $58.15	Professional	TC	$19.09	$29.92	$58.15
Molina Facility/Professional Professional Modifier Low / Median / High Price $17.95 / $65.98 / $212.53	Professional		$17.95	$65.98	$212.53
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $59.38 / $71.61 / $75.48	Facility	26	$59.38	$71.61	$75.48
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $43.82 / $59.16 / $82.49	Professional	26	$43.82	$59.16	$82.49
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $23.72 / $35.40 / $81.69	Professional	TC	$23.72	$35.40	$81.69
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $49.36 / $50.28 / $50.28	Facility	26	$49.36	$50.28	$50.28
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $117.38 / $178.10 / $213.17	Professional		$117.38	$178.10	$213.17
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $56.00 / $81.56 / $98.30	Professional	26	$56.00	$81.56	$98.30
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $63.44 / $92.62 / $115.20	Professional	TC	$63.44	$92.62	$115.20
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $72.06 / $72.06 / $127.19	Facility	26	$72.06	$72.06	$127.19
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $98.80 / $141.09 / $197.54	Professional		$98.80	$141.09	$197.54
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $51.28 / $68.17 / $91.77	Professional	26	$51.28	$68.17	$91.77
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $52.46 / $76.56 / $104.75	Professional	TC	$52.46	$76.56	$104.75
United Facility/Professional Professional Modifier Low / Median / High Price $75.44 / $106.14 / $208.53	Professional		$75.44	$106.14	$208.53
United Facility/Professional Professional Modifier 26 Low / Median / High Price $45.06 / $62.41 / $105.93	Professional	26	$45.06	$62.41	$105.93
United Facility/Professional Professional Modifier TC Low / Median / High Price $27.90 / $51.14 / $113.02	Professional	TC	$27.90	$51.14	$113.02
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $64.04 / $86.79 / $86.79	Professional		$64.04	$86.79	$86.79
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $29.81 / $37.97 / $37.97	Professional	26	$29.81	$37.97	$37.97
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $34.22 / $48.82 / $48.82	Professional	TC	$34.22	$48.82	$48.82