Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $48.75 / $65.70 / $109.73	Facility	26	$48.75	$65.70	$109.73
Aetna Facility/Professional Professional Modifier Low / Median / High Price $165.25 / $240.93 / $808.75	Professional		$165.25	$240.93	$808.75
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $40.94 / $63.40 / $173.30	Professional	26	$40.94	$63.40	$173.30
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $119.51 / $169.58 / $306.11	Professional	TC	$119.51	$169.58	$306.11
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $104.40 / $276.27 / $437.66	Professional		$104.40	$276.27	$437.66
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $29.76 / $60.26 / $67.56	Professional	26	$29.76	$60.26	$67.56
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $88.37 / $211.40 / $251.76	Facility	26	$88.37	$211.40	$251.76
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $219.45 / $397.69 / $1,354.08	Professional		$219.45	$397.69	$1,354.08
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $55.09 / $99.18 / $335.64	Professional	26	$55.09	$99.18	$335.64
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $171.23 / $304.92 / $1,018.44	Professional	TC	$171.23	$304.92	$1,018.44
Cigna Facility/Professional Professional Modifier Low / Median / High Price $197.01 / $330.44 / $518.21	Professional		$197.01	$330.44	$518.21
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $46.85 / $78.22 / $123.91	Professional	26	$46.85	$78.22	$123.91
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $150.16 / $253.38 / $407.36	Professional	TC	$150.16	$253.38	$407.36
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $52.27 / $86.47 / $147.27	Facility	26	$52.27	$86.47	$147.27
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $196.85 / $350.76 / $523.12	Professional		$196.85	$350.76	$523.12
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $48.72 / $84.69 / $137.44	Professional	26	$48.72	$84.69	$137.44
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $143.53 / $267.14 / $384.65	Professional	TC	$143.53	$267.14	$384.65
Molina Facility/Professional Professional Modifier Low / Median / High Price $29.15 / $151.38 / $373.59	Professional		$29.15	$151.38	$373.59
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $61.55 / $73.81 / $96.40	Facility	26	$61.55	$73.81	$96.40
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $54.75 / $78.66 / $109.48	Professional	26	$54.75	$78.66	$109.48
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $170.06 / $233.83 / $289.42	Professional	TC	$170.06	$233.83	$289.42
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $50.74 / $50.74 / $51.18	Facility	26	$50.74	$50.74	$51.18
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $244.86 / $367.45 / $446.15	Professional		$244.86	$367.45	$446.15
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $57.74 / $85.38 / $104.98	Professional	26	$57.74	$85.38	$104.98
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $187.13 / $277.48 / $341.18	Professional	TC	$187.13	$277.48	$341.18
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 $219.45 / $312.92 / $421.50	Professional		$219.45	$312.92	$421.50
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $51.74 / $73.63 / $100.60	Professional	26	$51.74	$73.63	$100.60
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $167.71 / $239.30 / $322.32	Professional	TC	$167.71	$239.30	$322.32
United Facility/Professional Professional Modifier Low / Median / High Price $193.25 / $308.33 / $458.60	Professional		$193.25	$308.33	$458.60
United Facility/Professional Professional Modifier 26 Low / Median / High Price $47.04 / $78.95 / $111.67	Professional	26	$47.04	$78.95	$111.67
United Facility/Professional Professional Modifier TC Low / Median / High Price $145.88 / $225.68 / $350.47	Professional	TC	$145.88	$225.68	$350.47
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $168.62 / $168.62 / $168.62	Professional		$168.62	$168.62	$168.62
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $39.14 / $39.14 / $39.14	Professional	26	$39.14	$39.14	$39.14
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $129.47 / $129.47 / $129.47	Professional	TC	$129.47	$129.47	$129.47