Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $84.40 / $134.18 / $173.20	Facility	26	$84.40	$134.18	$173.20
Aetna Facility/Professional Professional Modifier Low / Median / High Price $93.19 / $140.06 / $377.00	Professional		$93.19	$140.06	$377.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $62.67 / $84.40 / $203.02	Professional	26	$62.67	$84.40	$203.02
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $30.51 / $52.54 / $97.74	Professional	TC	$30.51	$52.54	$97.74
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $144.21 / $165.18 / $213.43	Professional		$144.21	$165.18	$213.43
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $93.18 / $93.18 / $93.18	Professional	26	$93.18	$93.18	$93.18
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $81.09 / $140.60 / $284.70	Facility	26	$81.09	$140.60	$284.70
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $143.50 / $237.55 / $888.68	Professional		$143.50	$237.55	$888.68
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $80.89 / $136.19 / $488.63	Professional	26	$80.89	$136.19	$488.63
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $55.76 / $103.83 / $400.05	Professional	TC	$55.76	$103.83	$400.05
Cigna Facility/Professional Professional Modifier Low / Median / High Price $106.06 / $187.35 / $358.06	Professional		$106.06	$187.35	$358.06
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $67.19 / $112.74 / $196.03	Professional	26	$67.19	$112.74	$196.03
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $27.93 / $74.27 / $162.03	Professional	TC	$27.93	$74.27	$162.03
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $56.64 / $84.13 / $154.30	Facility	26	$56.64	$84.13	$154.30
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $80.59 / $121.44 / $231.19	Professional		$80.59	$121.44	$231.19
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $56.56 / $83.95 / $154.30	Professional	26	$56.56	$83.95	$154.30
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $23.24 / $36.22 / $73.19	Professional	TC	$23.24	$36.22	$73.19
Molina Facility/Professional Professional Modifier Low / Median / High Price $17.95 / $67.08 / $212.53	Professional		$17.95	$67.08	$212.53
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $97.35 / $117.84 / $121.72	Facility	26	$97.35	$117.84	$121.72
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $75.18 / $102.51 / $133.25	Professional	26	$75.18	$102.51	$133.25
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $35.11 / $49.13 / $80.62	Professional	TC	$35.11	$49.13	$80.62
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $80.89 / $81.09 / $81.09	Facility	26	$80.89	$81.09	$81.09
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $156.84 / $237.96 / $284.83	Professional		$156.84	$237.96	$284.83
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $91.97 / $133.94 / $160.56	Professional	26	$91.97	$133.94	$160.56
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $68.43 / $99.68 / $124.27	Professional	TC	$68.43	$99.68	$124.27
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 $146.85 / $190.28 / $263.94	Professional		$146.85	$190.28	$263.94
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $82.70 / $110.63 / $148.82	Professional	26	$82.70	$110.63	$148.82
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $56.53 / $82.36 / $113.00	Professional	TC	$56.53	$82.36	$113.00
United Facility/Professional Professional Modifier Low / Median / High Price $111.84 / $149.46 / $286.39	Professional		$111.84	$149.46	$286.39
United Facility/Professional Professional Modifier 26 Low / Median / High Price $72.56 / $103.88 / $178.20	Professional	26	$72.56	$103.88	$178.20
United Facility/Professional Professional Modifier TC Low / Median / High Price $36.47 / $58.58 / $132.04	Professional	TC	$36.47	$58.58	$132.04
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $86.13 / $115.37 / $115.37	Professional		$86.13	$115.37	$115.37
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $49.14 / $62.61 / $62.61	Professional	26	$49.14	$62.61	$62.61
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $36.99 / $52.76 / $52.76	Professional	TC	$36.99	$52.76	$52.76