Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $57.37 / $77.66 / $123.08	Facility	26	$57.37	$77.66	$123.08
Aetna Facility/Professional Professional Modifier Low / Median / High Price $109.56 / $148.08 / $219.17	Professional		$109.56	$148.08	$219.17
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $40.09 / $48.09 / $77.00	Professional	26	$40.09	$48.09	$77.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $69.45 / $105.16 / $159.61	Professional	TC	$69.45	$105.16	$159.61
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $89.82 / $105.67 / $114.26	Professional		$89.82	$105.67	$114.26
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $43.22 / $43.22 / $43.22	Professional	26	$43.22	$43.22	$43.22
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $59.87 / $198.29 / $198.29	Facility	26	$59.87	$198.29	$198.29
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $142.00 / $259.16 / $1,048.88	Professional		$142.00	$259.16	$1,048.88
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $51.44 / $92.68 / $386.24	Professional	26	$51.44	$92.68	$386.24
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $82.90 / $160.06 / $782.04	Professional	TC	$82.90	$160.06	$782.04
Cigna Facility/Professional Professional Modifier Low / Median / High Price $129.47 / $228.75 / $378.85	Professional		$129.47	$228.75	$378.85
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $45.57 / $78.79 / $131.09	Professional	26	$45.57	$78.79	$131.09
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $83.49 / $148.12 / $257.42	Professional	TC	$83.49	$148.12	$257.42
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $38.64 / $65.76 / $115.34	Facility	26	$38.64	$65.76	$115.34
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $104.50 / $181.42 / $374.88	Professional		$104.50	$181.42	$374.88
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $38.47 / $62.30 / $108.40	Professional	26	$38.47	$62.30	$108.40
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $67.48 / $118.23 / $268.12	Professional	TC	$67.48	$118.23	$268.12
Molina Facility/Professional Professional Modifier Low / Median / High Price $27.49 / $109.01 / $295.97	Professional		$27.49	$109.01	$295.97
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $64.68 / $86.47 / $88.44	Facility	26	$64.68	$86.47	$88.44
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $52.66 / $67.73 / $99.16	Professional	26	$52.66	$67.73	$99.16
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $95.20 / $145.38 / $259.26	Professional	TC	$95.20	$145.38	$259.26
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $59.34 / $59.34 / $59.87	Facility	26	$59.34	$59.34	$59.87
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $172.17 / $275.37 / $339.18	Professional		$172.17	$275.37	$339.18
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $62.04 / $98.03 / $119.30	Professional	26	$62.04	$98.03	$119.30
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $110.54 / $179.14 / $220.27	Professional	TC	$110.54	$179.14	$220.27
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $217.18 / $217.18 / $354.01	Facility	26	$217.18	$217.18	$354.01
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $173.25 / $240.61 / $324.08	Professional		$173.25	$240.61	$324.08
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $60.52 / $85.21 / $115.40	Professional	26	$60.52	$85.21	$115.40
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $112.73 / $154.49 / $211.08	Professional	TC	$112.73	$154.49	$211.08
United Facility/Professional Professional Modifier Low / Median / High Price $137.74 / $220.15 / $355.58	Professional		$137.74	$220.15	$355.58
United Facility/Professional Professional Modifier 26 Low / Median / High Price $49.57 / $75.44 / $131.60	Professional	26	$49.57	$75.44	$131.60
United Facility/Professional Professional Modifier TC Low / Median / High Price $92.37 / $149.40 / $230.67	Professional	TC	$92.37	$149.40	$230.67
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $97.45 / $117.41 / $133.56	Professional		$97.45	$117.41	$133.56
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $36.15 / $42.80 / $46.07	Professional	26	$36.15	$42.80	$46.07
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $61.29 / $74.59 / $87.49	Professional	TC	$61.29	$74.59	$87.49