Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $30.03 / $39.97 / $66.75	Facility	26	$30.03	$39.97	$66.75
Aetna Facility/Professional Professional Modifier Low / Median / High Price $116.76 / $169.99 / $345.81	Professional		$116.76	$169.99	$345.81
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $14.49 / $25.13 / $60.36	Professional	26	$14.49	$25.13	$60.36
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $97.54 / $133.32 / $274.39	Professional	TC	$97.54	$133.32	$274.39
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $95.75 / $95.75 / $95.75	Professional		$95.75	$95.75	$95.75
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $12.87 / $36.36 / $62.20	Professional	26	$12.87	$36.36	$62.20
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $53.56 / $102.96 / $102.96	Facility	26	$53.56	$102.96	$102.96
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $172.79 / $310.79 / $1,075.95	Professional		$172.79	$310.79	$1,075.95
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $31.51 / $51.80 / $203.09	Professional	26	$31.51	$51.80	$203.09
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $142.06 / $250.86 / $934.78	Professional	TC	$142.06	$250.86	$934.78
Cigna Facility/Professional Professional Modifier Low / Median / High Price $155.53 / $256.36 / $405.39	Professional		$155.53	$256.36	$405.39
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $22.53 / $40.20 / $74.03	Professional	26	$22.53	$40.20	$74.03
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $126.60 / $212.32 / $343.30	Professional	TC	$126.60	$212.32	$343.30
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $18.04 / $37.13 / $81.99	Facility	26	$18.04	$37.13	$81.99
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $151.28 / $276.76 / $399.67	Professional		$151.28	$276.76	$399.67
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $18.48 / $37.11 / $61.63	Professional	26	$18.48	$37.11	$61.63
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $129.01 / $232.65 / $341.43	Professional	TC	$129.01	$232.65	$341.43
Molina Facility/Professional Professional Modifier Low / Median / High Price $28.80 / $143.84 / $310.91	Professional		$28.80	$143.84	$310.91
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $28.82 / $44.47 / $46.90	Facility	26	$28.82	$44.47	$46.90
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $23.00 / $35.11 / $55.30	Professional	26	$23.00	$35.11	$55.30
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $137.88 / $203.10 / $262.55	Professional	TC	$137.88	$203.10	$262.55
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $31.53 / $31.53 / $31.71	Facility	26	$31.53	$31.53	$31.71
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $190.74 / $282.81 / $347.74	Professional		$190.74	$282.81	$347.74
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $34.93 / $52.60 / $64.67	Professional	26	$34.93	$52.60	$64.67
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $155.68 / $230.21 / $283.06	Professional	TC	$155.68	$230.21	$283.06
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $211.40 / $211.40 / $385.75	Facility	26	$211.40	$211.40	$385.75
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $172.79 / $243.89 / $328.52	Professional		$172.79	$243.89	$328.52
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $32.34 / $45.23 / $61.10	Professional	26	$32.34	$45.23	$61.10
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $140.44 / $198.53 / $271.26	Professional	TC	$140.44	$198.53	$271.26
United Facility/Professional Professional Modifier Low / Median / High Price $149.91 / $227.71 / $365.65	Professional		$149.91	$227.71	$365.65
United Facility/Professional Professional Modifier 26 Low / Median / High Price $22.00 / $37.40 / $68.94	Professional	26	$22.00	$37.40	$68.94
United Facility/Professional Professional Modifier TC Low / Median / High Price $123.48 / $202.95 / $291.58	Professional	TC	$123.48	$202.95	$291.58
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $140.86 / $140.86 / $140.86	Professional		$140.86	$140.86	$140.86
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $23.50 / $23.50 / $23.50	Professional	26	$23.50	$23.50	$23.50
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $117.36 / $117.36 / $117.36	Professional	TC	$117.36	$117.36	$117.36