Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $78.62 / $129.37 / $196.52	Facility	26	$78.62	$129.37	$196.52
Aetna Facility/Professional Professional Modifier Low / Median / High Price $147.21 / $174.95 / $371.00	Professional		$147.21	$174.95	$371.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $52.54 / $78.62 / $196.20	Professional	26	$52.54	$78.62	$196.20
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $86.90 / $110.49 / $249.55	Professional	TC	$86.90	$110.49	$249.55
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $38.40 / $110.68 / $124.10	Professional	26	$38.40	$110.68	$124.10
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $646.64 / $646.64 / $646.64	Facility	26	$646.64	$646.64	$646.64
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $190.57 / $328.31 / $1,406.40	Professional		$190.57	$328.31	$1,406.40
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $95.63 / $164.65 / $569.92	Professional	26	$95.63	$164.65	$569.92
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $100.72 / $176.73 / $1,140.03	Professional	TC	$100.72	$176.73	$1,140.03
Cigna Facility/Professional Professional Modifier Low / Median / High Price $147.47 / $285.74 / $439.68	Professional		$147.47	$285.74	$439.68
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $66.09 / $122.72 / $207.41	Professional	26	$66.09	$122.72	$207.41
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $79.89 / $152.33 / $244.79	Professional	TC	$79.89	$152.33	$244.79
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $53.01 / $114.58 / $156.90	Facility	26	$53.01	$114.58	$156.90
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $134.22 / $262.70 / $451.87	Professional		$134.22	$262.70	$451.87
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $60.40 / $118.17 / $164.96	Professional	26	$60.40	$118.17	$164.96
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $72.03 / $146.93 / $303.72	Professional	TC	$72.03	$146.93	$303.72
Molina Facility/Professional Professional Modifier Low / Median / High Price $21.86 / $135.10 / $300.23	Professional		$21.86	$135.10	$300.23
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $92.91 / $132.16 / $140.69	Facility	26	$92.91	$132.16	$140.69
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $74.33 / $97.44 / $127.87	Professional	26	$74.33	$97.44	$127.87
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $86.83 / $120.00 / $185.26	Professional	TC	$86.83	$120.00	$185.26
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $93.69 / $93.69 / $93.77	Facility	26	$93.69	$93.69	$93.77
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $217.81 / $327.93 / $390.85	Professional		$217.81	$327.93	$390.85
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $102.32 / $158.66 / $192.15	Professional	26	$102.32	$158.66	$192.15
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $106.25 / $166.72 / $201.82	Professional	TC	$106.25	$166.72	$201.82
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $196.35 / $285.64 / $380.04	Professional		$196.35	$285.64	$380.04
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $95.63 / $140.43 / $184.13	Professional	26	$95.63	$140.43	$184.13
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $100.72 / $145.22 / $198.20	Professional	TC	$100.72	$145.22	$198.20
United Facility/Professional Professional Modifier Low / Median / High Price $130.68 / $170.40 / $407.41	Professional		$130.68	$170.40	$407.41
United Facility/Professional Professional Modifier 26 Low / Median / High Price $58.23 / $75.79 / $204.56	Professional	26	$58.23	$75.79	$204.56
United Facility/Professional Professional Modifier TC Low / Median / High Price $66.26 / $119.87 / $219.11	Professional	TC	$66.26	$119.87	$219.11
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $139.51 / $139.51 / $139.51	Professional		$139.51	$139.51	$139.51
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $71.76 / $71.76 / $71.76	Professional	26	$71.76	$71.76	$71.76
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $67.76 / $67.76 / $67.76	Professional	TC	$67.76	$67.76	$67.76