Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $40.63 / $59.80 / $150.05	Facility	26	$40.63	$59.80	$150.05
Aetna Facility/Professional Professional Modifier Low / Median / High Price $88.71 / $156.85 / $308.83	Professional		$88.71	$156.85	$308.83
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $15.71 / $38.45 / $84.49	Professional	26	$15.71	$38.45	$84.49
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $50.69 / $117.32 / $257.54	Professional	TC	$50.69	$117.32	$257.54
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $25.60 / $51.00 / $87.06	Professional	26	$25.60	$51.00	$87.06
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $100.00 / $205.87 / $205.87	Facility	26	$100.00	$205.87	$205.87
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $134.44 / $230.85 / $2,899.89	Professional		$134.44	$230.85	$2,899.89
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $41.38 / $99.78 / $425.60	Professional	26	$41.38	$99.78	$425.60
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $73.33 / $137.44 / $2,808.09	Professional	TC	$73.33	$137.44	$2,808.09
Cigna Facility/Professional Professional Modifier Low / Median / High Price $102.69 / $200.76 / $341.02	Professional		$102.69	$200.76	$341.02
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $20.27 / $59.26 / $135.41	Professional	26	$20.27	$59.26	$135.41
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $65.02 / $124.55 / $288.50	Professional	TC	$65.02	$124.55	$288.50
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $16.57 / $35.52 / $103.08	Facility	26	$16.57	$35.52	$103.08
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $94.55 / $197.12 / $457.31	Professional		$94.55	$197.12	$457.31
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $15.95 / $35.99 / $109.91	Professional	26	$15.95	$35.99	$109.91
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $78.70 / $140.22 / $416.53	Professional	TC	$78.70	$140.22	$416.53
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 $28.50 / $86.87 / $91.79	Facility	26	$28.50	$86.87	$91.79
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $23.15 / $31.32 / $77.52	Professional	26	$23.15	$31.32	$77.52
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $83.09 / $129.97 / $241.28	Professional	TC	$83.09	$129.97	$241.28
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $62.06 / $62.06 / $62.15	Facility	26	$62.06	$62.06	$62.15
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $150.21 / $227.56 / $284.54	Professional		$150.21	$227.56	$284.54
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $66.86 / $106.95 / $129.47	Professional	26	$66.86	$106.95	$129.47
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $79.48 / $120.47 / $156.31	Professional	TC	$79.48	$120.47	$156.31
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $134.44 / $199.99 / $271.76	Professional		$134.44	$199.99	$271.76
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $63.29 / $93.16 / $127.62	Professional	26	$63.29	$93.16	$127.62
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $73.92 / $107.48 / $163.40	Professional	TC	$73.92	$107.48	$163.40
United Facility/Professional Professional Modifier Low / Median / High Price $104.27 / $175.15 / $334.21	Professional		$104.27	$175.15	$334.21
United Facility/Professional Professional Modifier 26 Low / Median / High Price $18.80 / $51.07 / $130.16	Professional	26	$18.80	$51.07	$130.16
United Facility/Professional Professional Modifier TC Low / Median / High Price $59.91 / $108.57 / $199.81	Professional	TC	$59.91	$108.57	$199.81
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $106.53 / $106.53 / $106.53	Professional		$106.53	$106.53	$106.53
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $47.06 / $47.06 / $47.06	Professional	26	$47.06	$47.06	$47.06
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $59.47 / $59.47 / $59.47	Professional	TC	$59.47	$59.47	$59.47