Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $59.00 / $111.67 / $205.66	Facility	26	$59.00	$111.67	$205.66
Aetna Facility/Professional Professional Modifier Low / Median / High Price $131.25 / $194.71 / $700.20	Professional		$131.25	$194.71	$700.20
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $56.92 / $79.06 / $619.29	Professional	26	$56.92	$79.06	$619.29
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $68.76 / $102.67 / $196.42	Professional	TC	$68.76	$102.67	$196.42
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $99.20 / $112.65 / $333.15	Professional		$99.20	$112.65	$333.15
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $50.74 / $63.31 / $119.81	Professional	26	$50.74	$63.31	$119.81
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $79.73 / $347.58 / $657.04	Facility	26	$79.73	$347.58	$657.04
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $168.17 / $295.27 / $1,075.80	Professional		$168.17	$295.27	$1,075.80
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $82.26 / $141.69 / $855.01	Professional	26	$82.26	$141.69	$855.01
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $90.03 / $152.81 / $724.87	Professional	TC	$90.03	$152.81	$724.87
Cigna Facility/Professional Professional Modifier Low / Median / High Price $154.31 / $264.50 / $401.88	Professional		$154.31	$264.50	$401.88
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $73.70 / $121.28 / $192.12	Professional	26	$73.70	$121.28	$192.12
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $83.26 / $139.78 / $219.42	Professional	TC	$83.26	$139.78	$219.42
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $56.11 / $136.44 / $1,073.72	Facility	26	$56.11	$136.44	$1,073.72
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $137.63 / $283.92 / $388.14	Professional		$137.63	$283.92	$388.14
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $56.32 / $130.86 / $162.30	Professional	26	$56.32	$130.86	$162.30
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $82.15 / $153.06 / $236.96	Professional	TC	$82.15	$153.06	$236.96
Molina Facility/Professional Professional Modifier Low / Median / High Price $21.18 / $122.26 / $273.82	Professional		$21.18	$122.26	$273.82
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $89.18 / $116.58 / $120.60	Facility	26	$89.18	$116.58	$120.60
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $103.25 / $103.25 / $103.25	Professional		$103.25	$103.25	$103.25
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $66.55 / $101.94 / $121.72	Professional	26	$66.55	$101.94	$121.72
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $79.55 / $124.20 / $161.47	Professional	TC	$79.55	$124.20	$161.47
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $79.73 / $79.73 / $82.26	Facility	26	$79.73	$79.73	$82.26
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $192.28 / $288.06 / $343.51	Professional		$192.28	$288.06	$343.51
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $92.27 / $137.21 / $163.28	Professional	26	$92.27	$137.21	$163.28
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $100.01 / $150.16 / $178.70	Professional	TC	$100.01	$150.16	$178.70
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $657.04 / $657.04 / $1,088.88	Facility	26	$657.04	$657.04	$1,088.88
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $168.17 / $258.25 / $339.37	Professional		$168.17	$258.25	$339.37
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $81.31 / $123.30 / $161.68	Professional	26	$81.31	$123.30	$161.68
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $86.86 / $134.22 / $182.10	Professional	TC	$86.86	$134.22	$182.10
United Facility/Professional Professional Modifier Low / Median / High Price $156.34 / $192.90 / $340.07	Professional		$156.34	$192.90	$340.07
United Facility/Professional Professional Modifier 26 Low / Median / High Price $73.43 / $80.40 / $170.06	Professional	26	$73.43	$80.40	$170.06
United Facility/Professional Professional Modifier TC Low / Median / High Price $81.33 / $111.89 / $168.04	Professional	TC	$81.33	$111.89	$168.04
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $142.78 / $142.78 / $142.78	Professional		$142.78	$142.78	$142.78
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $64.76 / $64.76 / $64.76	Professional	26	$64.76	$64.76	$64.76
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $78.02 / $78.02 / $78.02	Professional	TC	$78.02	$78.02	$78.02