Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $57.99 / $91.97 / $124.04	Facility	26	$57.99	$91.97	$124.04
Aetna Facility/Professional Professional Modifier Low / Median / High Price $72.39 / $105.89 / $204.26	Professional		$72.39	$105.89	$204.26
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $45.14 / $57.99 / $145.22	Professional	26	$45.14	$57.99	$145.22
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $26.17 / $48.50 / $83.84	Professional	TC	$26.17	$48.50	$83.84
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $173.20 / $173.20 / $173.20	Professional		$173.20	$173.20	$173.20
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $72.06 / $95.51 / $204.09	Facility	26	$72.06	$95.51	$204.09
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $114.25 / $190.18 / $711.23	Professional		$114.25	$190.18	$711.23
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $56.83 / $93.59 / $334.50	Professional	26	$56.83	$93.59	$334.50
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $50.67 / $97.86 / $376.73	Professional	TC	$50.67	$97.86	$376.73
Cigna Facility/Professional Professional Modifier Low / Median / High Price $80.06 / $149.44 / $286.47	Professional		$80.06	$149.44	$286.47
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $46.10 / $78.39 / $133.93	Professional	26	$46.10	$78.39	$133.93
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $25.68 / $69.86 / $152.54	Professional	TC	$25.68	$69.86	$152.54
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $39.99 / $59.14 / $110.33	Facility	26	$39.99	$59.14	$110.33
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $60.14 / $91.36 / $173.95	Professional		$60.14	$91.36	$173.95
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $39.99 / $59.14 / $106.74	Professional	26	$39.99	$59.14	$106.74
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $20.30 / $32.22 / $65.91	Professional	TC	$20.30	$32.22	$65.91
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 $66.51 / $80.04 / $85.76	Facility	26	$66.51	$80.04	$85.76
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $52.34 / $80.01 / $94.86	Professional	26	$52.34	$80.01	$94.86
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $31.01 / $44.22 / $86.43	Professional	TC	$31.01	$44.22	$86.43
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $55.30 / $55.72 / $55.72	Facility	26	$55.30	$55.72	$55.72
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $124.88 / $190.07 / $226.78	Professional		$124.88	$190.07	$226.78
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $63.20 / $92.04 / $109.81	Professional	26	$63.20	$92.04	$109.81
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $64.44 / $94.19 / $117.02	Professional	TC	$64.44	$94.19	$117.02
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 $111.88 / $150.82 / $210.82	Professional		$111.88	$150.82	$210.82
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $56.83 / $76.92 / $102.52	Professional	26	$56.83	$76.92	$102.52
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $53.28 / $77.72 / $106.40	Professional	TC	$53.28	$77.72	$106.40
United Facility/Professional Professional Modifier Low / Median / High Price $83.46 / $117.74 / $231.56	Professional		$83.46	$117.74	$231.56
United Facility/Professional Professional Modifier 26 Low / Median / High Price $50.02 / $72.81 / $118.76	Professional	26	$50.02	$72.81	$118.76
United Facility/Professional Professional Modifier TC Low / Median / High Price $31.35 / $50.95 / $124.44	Professional	TC	$31.35	$50.95	$124.44
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $68.19 / $92.13 / $92.13	Professional		$68.19	$92.13	$92.13
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $33.40 / $42.53 / $42.53	Professional	26	$33.40	$42.53	$42.53
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $34.79 / $49.60 / $49.60	Professional	TC	$34.79	$49.60	$49.60