Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $77.27 / $123.62 / $158.86	Facility	26	$77.27	$123.62	$158.86
Aetna Facility/Professional Professional Modifier Low / Median / High Price $84.65 / $129.49 / $357.00	Professional		$84.65	$129.49	$357.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $56.72 / $77.27 / $235.00	Professional	26	$56.72	$77.27	$235.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $26.89 / $48.10 / $86.15	Professional	TC	$26.89	$48.10	$86.15
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $133.59 / $176.88 / $197.71	Professional		$133.59	$176.88	$197.71
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $66.31 / $66.31 / $107.28	Professional	26	$66.31	$66.31	$107.28
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $74.75 / $129.41 / $248.27	Facility	26	$74.75	$129.41	$248.27
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $127.72 / $220.52 / $824.25	Professional		$127.72	$220.52	$824.25
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $74.48 / $125.55 / $450.38	Professional	26	$74.48	$125.55	$450.38
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $52.23 / $97.15 / $373.80	Professional	TC	$52.23	$97.15	$373.80
Cigna Facility/Professional Professional Modifier Low / Median / High Price $92.11 / $173.59 / $331.75	Professional		$92.11	$173.59	$331.75
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $61.46 / $102.85 / $180.39	Professional	26	$61.46	$102.85	$180.39
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $25.68 / $69.12 / $151.35	Professional	TC	$25.68	$69.12	$151.35
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $50.84 / $77.08 / $135.71	Facility	26	$50.84	$77.08	$135.71
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $73.55 / $109.92 / $207.24	Professional		$73.55	$109.92	$207.24
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $50.84 / $74.76 / $133.99	Professional	26	$50.84	$74.76	$133.99
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $20.44 / $33.03 / $65.94	Professional	TC	$20.44	$33.03	$65.94
Molina Facility/Professional Professional Modifier Low / Median / High Price $17.95 / $66.08 / $212.53	Professional		$17.95	$66.08	$212.53
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $89.65 / $108.50 / $111.22	Facility	26	$89.65	$108.50	$111.22
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $68.88 / $97.80 / $124.29	Professional	26	$68.88	$97.80	$124.29
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $30.10 / $42.75 / $73.08	Professional	TC	$30.10	$42.75	$73.08
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $74.48 / $74.75 / $74.75	Facility	26	$74.48	$74.75	$74.75
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $145.35 / $220.75 / $263.97	Professional		$145.35	$220.75	$263.97
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $84.78 / $123.47 / $147.86	Professional	26	$84.78	$123.47	$147.86
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $63.94 / $93.40 / $116.11	Professional	TC	$63.94	$93.40	$116.11
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 $133.76 / $176.35 / $244.85	Professional		$133.76	$176.35	$244.85
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $76.23 / $101.41 / $136.94	Professional	26	$76.23	$101.41	$136.94
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $52.87 / $77.14 / $105.57	Professional	TC	$52.87	$77.14	$105.57
United Facility/Professional Professional Modifier Low / Median / High Price $104.00 / $153.40 / $280.26	Professional		$104.00	$153.40	$280.26
United Facility/Professional Professional Modifier 26 Low / Median / High Price $66.40 / $88.09 / $159.86	Professional	26	$66.40	$88.09	$159.86
United Facility/Professional Professional Modifier TC Low / Median / High Price $32.65 / $54.51 / $113.92	Professional	TC	$32.65	$54.51	$113.92
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $79.78 / $106.87 / $106.87	Professional		$79.78	$106.87	$106.87
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $45.28 / $57.66 / $57.66	Professional	26	$45.28	$57.66	$57.66
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $34.51 / $49.21 / $49.21	Professional	TC	$34.51	$49.21	$49.21