Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $73.64 / $120.96 / $188.43	Facility	26	$73.64	$120.96	$188.43
Aetna Facility/Professional Professional Modifier Low / Median / High Price $118.33 / $201.82 / $376.42	Professional		$118.33	$201.82	$376.42
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $49.65 / $69.36 / $146.91	Professional	26	$49.65	$69.36	$146.91
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $59.24 / $144.61 / $304.10	Professional	TC	$59.24	$144.61	$304.10
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $55.92 / $55.92 / $102.61	Professional	26	$55.92	$55.92	$102.61
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $135.87 / $302.75 / $302.75	Facility	26	$135.87	$302.75	$302.75
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $176.48 / $308.66 / $3,098.01	Professional		$176.48	$308.66	$3,098.01
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $92.40 / $147.91 / $636.41	Professional	26	$92.40	$147.91	$636.41
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $87.36 / $162.74 / $2,808.09	Professional	TC	$87.36	$162.74	$2,808.09
Cigna Facility/Professional Professional Modifier Low / Median / High Price $150.37 / $264.94 / $440.15	Professional		$150.37	$264.94	$440.15
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $58.07 / $106.49 / $198.47	Professional	26	$58.07	$106.49	$198.47
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $76.31 / $145.55 / $332.19	Professional	TC	$76.31	$145.55	$332.19
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $58.17 / $120.91 / $8,105.48	Facility	26	$58.17	$120.91	$8,105.48
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $144.15 / $297.70 / $576.42	Professional		$144.15	$297.70	$576.42
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $51.94 / $112.12 / $160.19	Professional	26	$51.94	$112.12	$160.19
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $92.56 / $165.24 / $448.51	Professional	TC	$92.56	$165.24	$448.51
Molina Facility/Professional Professional Modifier Low / Median / High Price $21.67 / $102.70 / $228.88	Professional		$21.67	$102.70	$228.88
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $84.27 / $120.00 / $133.33	Facility	26	$84.27	$120.00	$133.33
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $65.53 / $100.89 / $141.88	Professional	26	$65.53	$100.89	$141.88
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $92.06 / $146.56 / $248.32	Professional	TC	$92.06	$146.56	$248.32
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $90.60 / $90.60 / $90.94	Facility	26	$90.60	$90.60	$90.94
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $195.12 / $297.75 / $367.85	Professional		$195.12	$297.75	$367.85
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $98.40 / $154.03 / $186.52	Professional	26	$98.40	$154.03	$186.52
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $92.92 / $141.72 / $180.94	Professional	TC	$92.92	$141.72	$180.94
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $5,551.62 / $5,551.62 / $8,401.03	Facility	26	$5,551.62	$5,551.62	$8,401.03
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $176.48 / $262.27 / $356.84	Professional		$176.48	$262.27	$356.84
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $92.40 / $136.72 / $184.91	Professional	26	$92.40	$136.72	$184.91
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $87.36 / $126.00 / $192.24	Professional	TC	$87.36	$126.00	$192.24
United Facility/Professional Professional Modifier Low / Median / High Price $140.90 / $235.22 / $411.80	Professional		$140.90	$235.22	$411.80
United Facility/Professional Professional Modifier 26 Low / Median / High Price $58.79 / $79.00 / $188.11	Professional	26	$58.79	$79.00	$188.11
United Facility/Professional Professional Modifier TC Low / Median / High Price $69.65 / $130.00 / $224.24	Professional	TC	$69.65	$130.00	$224.24
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $137.52 / $137.52 / $137.52	Professional		$137.52	$137.52	$137.52
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $68.19 / $68.19 / $68.19	Professional	26	$68.19	$68.19	$68.19
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $69.34 / $69.34 / $69.34	Professional	TC	$69.34	$69.34	$69.34