Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $93.42 / $114.58 / $301.01	Facility	26	$93.42	$114.58	$301.01
Aetna Facility/Professional Professional Modifier Low / Median / High Price $193.50 / $235.13 / $543.60	Professional		$193.50	$235.13	$543.60
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $72.87 / $93.42 / $244.30	Professional	26	$72.87	$93.42	$244.30
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $119.70 / $150.21 / $305.73	Professional	TC	$119.70	$150.21	$305.73
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $186.18 / $345.59 / $521.51	Professional		$186.18	$345.59	$521.51
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $85.77 / $137.22 / $147.91	Professional	26	$85.77	$137.22	$147.91
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $195.14 / $195.14 / $228.81	Professional	TC	$195.14	$195.14	$228.81
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $446.45 / $770.72 / $770.72	Facility	26	$446.45	$770.72	$770.72
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $257.29 / $451.64 / $1,608.45	Professional		$257.29	$451.64	$1,608.45
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $113.19 / $199.02 / $677.40	Professional	26	$113.19	$199.02	$677.40
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $148.30 / $254.10 / $1,308.00	Professional	TC	$148.30	$254.10	$1,308.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $195.65 / $367.03 / $608.52	Professional		$195.65	$367.03	$608.52
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $82.10 / $150.78 / $268.51	Professional	26	$82.10	$150.78	$268.51
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $111.54 / $215.84 / $359.60	Professional	TC	$111.54	$215.84	$359.60
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $91.31 / $187.03 / $698.97	Facility	26	$91.31	$187.03	$698.97
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $212.97 / $436.60 / $575.47	Professional		$212.97	$436.60	$575.47
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $80.91 / $174.64 / $227.05	Professional	26	$80.91	$174.64	$227.05
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $136.71 / $247.19 / $359.45	Professional	TC	$136.71	$247.19	$359.45
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.48 / $190.88 / $427.77	Professional		$32.48	$190.88	$427.77
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $134.19 / $161.65 / $166.83	Facility	26	$134.19	$161.65	$166.83
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $110.48 / $148.19 / $172.82	Professional	26	$110.48	$148.19	$172.82
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $144.10 / $206.98 / $243.21	Professional	TC	$144.10	$206.98	$243.21
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $110.99 / $110.99 / $111.51	Facility	26	$110.99	$110.99	$111.51
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $292.80 / $442.74 / $535.98	Professional		$292.80	$442.74	$535.98
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $127.33 / $191.88 / $230.26	Professional	26	$127.33	$191.88	$230.26
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $165.48 / $251.18 / $303.69	Professional	TC	$165.48	$251.18	$303.69
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $446.45 / $446.45 / $782.93	Facility	26	$446.45	$446.45	$782.93
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $261.49 / $389.60 / $528.32	Professional		$261.49	$389.60	$528.32
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $113.19 / $168.85 / $228.09	Professional	26	$113.19	$168.85	$228.09
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $148.30 / $220.75 / $302.29	Professional	TC	$148.30	$220.75	$302.29
United Facility/Professional Professional Modifier Low / Median / High Price $172.70 / $253.46 / $548.39	Professional		$172.70	$253.46	$548.39
United Facility/Professional Professional Modifier 26 Low / Median / High Price $75.77 / $93.13 / $234.65	Professional	26	$75.77	$93.13	$234.65
United Facility/Professional Professional Modifier TC Low / Median / High Price $96.93 / $135.85 / $304.95	Professional	TC	$96.93	$135.85	$304.95
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $209.45 / $209.45 / $209.45	Professional		$209.45	$209.45	$209.45
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $85.77 / $85.77 / $85.77	Professional	26	$85.77	$85.77	$85.77
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $123.68 / $123.68 / $123.68	Professional	TC	$123.68	$123.68	$123.68