Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $44.36 / $60.02 / $92.35	Facility	26	$44.36	$60.02	$92.35
Aetna Facility/Professional Professional Modifier Low / Median / High Price $64.31 / $105.60 / $214.80	Professional		$64.31	$105.60	$214.80
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $29.58 / $36.35 / $75.88	Professional	26	$29.58	$36.35	$75.88
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $33.03 / $68.31 / $127.53	Professional	TC	$33.03	$68.31	$127.53
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $101.27 / $202.54 / $214.17	Professional		$101.27	$202.54	$214.17
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $31.89 / $33.28 / $66.19	Professional	26	$31.89	$33.28	$66.19
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $46.16 / $152.90 / $152.90	Facility	26	$46.16	$152.90	$152.90
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $105.00 / $212.55 / $896.70	Professional		$105.00	$212.55	$896.70
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $39.67 / $71.45 / $281.33	Professional	26	$39.67	$71.45	$281.33
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $66.79 / $145.25 / $615.45	Professional	TC	$66.79	$145.25	$615.45
Cigna Facility/Professional Professional Modifier Low / Median / High Price $56.06 / $138.62 / $318.39	Professional		$56.06	$138.62	$318.39
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $34.13 / $60.23 / $101.59	Professional	26	$34.13	$60.23	$101.59
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $35.11 / $96.55 / $217.93	Professional	TC	$35.11	$96.55	$217.93
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $29.12 / $48.07 / $86.28	Facility	26	$29.12	$48.07	$86.28
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $60.78 / $112.32 / $203.30	Professional		$60.78	$112.32	$203.30
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $28.79 / $45.91 / $80.98	Professional	26	$28.79	$45.91	$80.98
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $25.13 / $57.78 / $119.74	Professional	TC	$25.13	$57.78	$119.74
Molina Facility/Professional Professional Modifier Low / Median / High Price $22.43 / $100.65 / $232.98	Professional		$22.43	$100.65	$232.98
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $48.02 / $65.66 / $67.67	Facility	26	$48.02	$65.66	$67.67
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $39.79 / $58.41 / $70.56	Professional	26	$39.79	$58.41	$70.56
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $46.23 / $82.11 / $133.88	Professional	TC	$46.23	$82.11	$133.88
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $45.75 / $45.75 / $46.16	Facility	26	$45.75	$45.75	$46.16
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $146.76 / $236.06 / $286.87	Professional		$146.76	$236.06	$286.87
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $47.83 / $75.58 / $91.98	Professional	26	$47.83	$75.58	$91.98
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $99.25 / $160.13 / $191.40	Professional	TC	$99.25	$160.13	$191.40
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $270.73 / $270.73 / $459.43	Facility	26	$270.73	$270.73	$459.43
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $147.38 / $202.95 / $270.19	Professional		$147.38	$202.95	$270.19
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $46.66 / $65.70 / $88.97	Professional	26	$46.66	$65.70	$88.97
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $100.72 / $137.25 / $181.47	Professional	TC	$100.72	$137.25	$181.47
United Facility/Professional Professional Modifier Low / Median / High Price $91.05 / $153.18 / $304.12	Professional		$91.05	$153.18	$304.12
United Facility/Professional Professional Modifier 26 Low / Median / High Price $41.58 / $56.04 / $99.45	Professional	26	$41.58	$56.04	$99.45
United Facility/Professional Professional Modifier TC Low / Median / High Price $48.22 / $96.86 / $206.59	Professional	TC	$48.22	$96.86	$206.59
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $83.92 / $101.27 / $115.77	Professional		$83.92	$101.27	$115.77
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $27.88 / $33.04 / $35.78	Professional	26	$27.88	$33.04	$35.78
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $56.04 / $68.20 / $79.98	Professional	TC	$56.04	$68.20	$79.98