Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $60.63 / $90.05 / $124.01	Facility	26	$60.63	$90.05	$124.01
Aetna Facility/Professional Professional Modifier Low / Median / High Price $144.46 / $195.99 / $377.85	Professional		$144.46	$195.99	$377.85
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $43.78 / $60.63 / $120.28	Professional	26	$43.78	$60.63	$120.28
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $99.57 / $144.53 / $235.15	Professional	TC	$99.57	$144.53	$235.15
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $105.64 / $105.64 / $105.64	Professional		$105.64	$105.64	$105.64
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $101.58 / $214.35 / $214.35	Facility	26	$101.58	$214.35	$214.35
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $192.39 / $348.08 / $1,173.53	Professional		$192.39	$348.08	$1,173.53
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $59.65 / $101.54 / $449.09	Professional	26	$59.65	$101.54	$449.09
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $132.47 / $222.92 / $867.64	Professional	TC	$132.47	$222.92	$867.64
Cigna Facility/Professional Professional Modifier Low / Median / High Price $169.26 / $264.57 / $441.83	Professional		$169.26	$264.57	$441.83
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $51.59 / $80.59 / $140.37	Professional	26	$51.59	$80.59	$140.37
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $116.08 / $182.77 / $315.44	Professional	TC	$116.08	$182.77	$315.44
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $44.43 / $91.98 / $151.63	Facility	26	$44.43	$91.98	$151.63
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $139.81 / $267.72 / $424.19	Professional		$139.81	$267.72	$424.19
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $42.56 / $89.28 / $119.81	Professional	26	$42.56	$89.28	$119.81
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $94.36 / $183.52 / $302.83	Professional	TC	$94.36	$183.52	$302.83
Molina Facility/Professional Professional Modifier Low / Median / High Price $28.80 / $143.84 / $310.91	Professional		$28.80	$143.84	$310.91
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $68.59 / $84.73 / $88.40	Facility	26	$68.59	$84.73	$88.40
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $57.60 / $75.52 / $92.40	Professional	26	$57.60	$75.52	$92.40
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $112.33 / $146.61 / $197.34	Professional	TC	$112.33	$146.61	$197.34
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $58.04 / $58.04 / $58.44	Facility	26	$58.04	$58.04	$58.44
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $210.84 / $311.77 / $383.36	Professional		$210.84	$311.77	$383.36
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $65.98 / $97.40 / $119.04	Professional	26	$65.98	$97.40	$119.04
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $144.86 / $214.97 / $264.32	Professional	TC	$144.86	$214.97	$264.32
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $446.45 / $446.45 / $1,640.24	Facility	26	$446.45	$446.45	$1,640.24
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $191.73 / $269.75 / $362.17	Professional		$191.73	$269.75	$362.17
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $59.60 / $83.85 / $114.07	Professional	26	$59.60	$83.85	$114.07
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $132.13 / $185.90 / $249.71	Professional	TC	$132.13	$185.90	$249.71
United Facility/Professional Professional Modifier Low / Median / High Price $155.34 / $250.41 / $395.02	Professional		$155.34	$250.41	$395.02
United Facility/Professional Professional Modifier 26 Low / Median / High Price $49.91 / $76.70 / $126.48	Professional	26	$49.91	$76.70	$126.48
United Facility/Professional Professional Modifier TC Low / Median / High Price $105.70 / $168.96 / $271.29	Professional	TC	$105.70	$168.96	$271.29
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $153.96 / $153.96 / $153.96	Professional		$153.96	$153.96	$153.96
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $44.89 / $44.89 / $44.89	Professional	26	$44.89	$44.89	$44.89
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $109.07 / $109.07 / $109.07	Professional	TC	$109.07	$109.07	$109.07