Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $101.81 / $147.32 / $216.58	Facility	26	$101.81	$147.32	$216.58
Aetna Facility/Professional Professional Modifier Low / Median / High Price $146.91 / $261.97 / $474.42	Professional		$146.91	$261.97	$474.42
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $56.82 / $87.39 / $191.60	Professional	26	$56.82	$87.39	$191.60
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $70.77 / $141.55 / $338.97	Professional	TC	$70.77	$141.55	$338.97
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $255.94 / $255.94 / $255.94	Professional		$255.94	$255.94	$255.94
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $74.80 / $74.80 / $74.80	Professional	26	$74.80	$74.80	$74.80
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $188.19 / $413.29 / $413.29	Facility	26	$188.19	$413.29	$413.29
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $225.46 / $390.62 / $3,140.08	Professional		$225.46	$390.62	$3,140.08
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $124.30 / $214.98 / $767.78	Professional	26	$124.30	$214.98	$767.78
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $103.82 / $194.01 / $2,808.09	Professional	TC	$103.82	$194.01	$2,808.09
Cigna Facility/Professional Professional Modifier Low / Median / High Price $198.80 / $344.17 / $561.82	Professional		$198.80	$344.17	$561.82
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $76.05 / $150.65 / $273.11	Professional	26	$76.05	$150.65	$273.11
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $95.49 / $176.72 / $390.49	Professional	TC	$95.49	$176.72	$390.49
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $84.63 / $160.19 / $8,105.48	Facility	26	$84.63	$160.19	$8,105.48
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $200.26 / $402.37 / $680.37	Professional		$200.26	$402.37	$680.37
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $84.63 / $156.97 / $240.37	Professional	26	$84.63	$156.97	$240.37
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $119.68 / $215.81 / $532.46	Professional	TC	$119.68	$215.81	$532.46
Molina Facility/Professional Professional Modifier Low / Median / High Price $29.04 / $157.43 / $360.43	Professional		$29.04	$157.43	$360.43
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $103.74 / $171.94 / $182.24	Facility	26	$103.74	$171.94	$182.24
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $82.99 / $109.75 / $181.57	Professional	26	$82.99	$109.75	$181.57
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $116.52 / $231.15 / $302.27	Professional	TC	$116.52	$231.15	$302.27
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $123.67 / $123.67 / $124.30	Facility	26	$123.67	$123.67	$124.30
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $250.87 / $382.82 / $467.06	Professional		$250.87	$382.82	$467.06
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $132.25 / $210.53 / $255.53	Professional	26	$132.25	$210.53	$255.53
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $110.98 / $169.74 / $212.97	Professional	TC	$110.98	$169.74	$212.97
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 $225.46 / $337.70 / $500.93	Professional		$225.46	$337.70	$500.93
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $126.13 / $187.58 / $253.09	Professional	26	$126.13	$187.58	$253.09
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $103.20 / $150.05 / $228.14	Professional	TC	$103.20	$150.05	$228.14
United Facility/Professional Professional Modifier Low / Median / High Price $178.28 / $303.08 / $493.04	Professional		$178.28	$303.08	$493.04
United Facility/Professional Professional Modifier 26 Low / Median / High Price $68.59 / $101.01 / $253.91	Professional	26	$68.59	$101.01	$253.91
United Facility/Professional Professional Modifier TC Low / Median / High Price $80.48 / $144.06 / $267.88	Professional	TC	$80.48	$144.06	$267.88
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $178.17 / $178.17 / $178.17	Professional		$178.17	$178.17	$178.17
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $93.96 / $93.96 / $93.96	Professional	26	$93.96	$93.96	$93.96
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $84.21 / $84.21 / $84.21	Professional	TC	$84.21	$84.21	$84.21