Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $104.57 / $140.68 / $221.84	Facility	26	$104.57	$140.68	$221.84
Aetna Facility/Professional Professional Modifier Low / Median / High Price $130.08 / $162.40 / $335.40	Professional		$130.08	$162.40	$335.40
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $72.13 / $84.60 / $151.72	Professional	26	$72.13	$84.60	$151.72
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $55.03 / $81.30 / $146.81	Professional	TC	$55.03	$81.30	$146.81
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $77.86 / $86.65 / $134.40	Professional	26	$77.86	$86.65	$134.40
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $108.77 / $358.77 / $358.77	Facility	26	$108.77	$358.77	$358.77
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $187.96 / $331.90 / $1,362.38	Professional		$187.96	$331.90	$1,362.38
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $97.17 / $169.87 / $662.55	Professional	26	$97.17	$169.87	$662.55
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $82.36 / $167.69 / $699.83	Professional	TC	$82.36	$167.69	$699.83
Cigna Facility/Professional Professional Modifier Low / Median / High Price $110.40 / $260.42 / $485.58	Professional		$110.40	$260.42	$485.58
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $82.14 / $142.68 / $239.38	Professional	26	$82.14	$142.68	$239.38
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $66.25 / $147.94 / $247.92	Professional	TC	$66.25	$147.94	$247.92
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $68.16 / $115.78 / $204.08	Facility	26	$68.16	$115.78	$204.08
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $126.06 / $219.27 / $412.64	Professional		$126.06	$219.27	$412.64
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $67.50 / $108.91 / $190.97	Professional	26	$67.50	$108.91	$190.97
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $42.77 / $98.67 / $216.98	Professional	TC	$42.77	$98.67	$216.98
Molina Facility/Professional Professional Modifier Low / Median / High Price $31.08 / $155.69 / $364.91	Professional		$31.08	$155.69	$364.91
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $115.64 / $156.63 / $159.46	Facility	26	$115.64	$156.63	$159.46
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $87.23 / $132.81 / $162.84	Professional	26	$87.23	$132.81	$162.84
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $71.91 / $120.96 / $176.64	Professional	TC	$71.91	$120.96	$176.64
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $108.27 / $108.27 / $108.77	Facility	26	$108.27	$108.27	$108.77
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $224.85 / $359.10 / $446.34	Professional		$224.85	$359.10	$446.34
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $112.24 / $177.35 / $215.89	Professional	26	$112.24	$177.35	$215.89
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $113.70 / $182.95 / $224.95	Professional	TC	$113.70	$182.95	$224.95
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $217.18 / $217.18 / $354.01	Facility	26	$217.18	$217.18	$354.01
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $226.38 / $312.18 / $423.27	Professional		$226.38	$312.18	$423.27
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $110.42 / $154.82 / $208.77	Professional	26	$110.42	$154.82	$208.77
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $115.96 / $157.78 / $215.57	Professional	TC	$115.96	$157.78	$215.57
United Facility/Professional Professional Modifier Low / Median / High Price $167.46 / $280.45 / $474.83	Professional		$167.46	$280.45	$474.83
United Facility/Professional Professional Modifier 26 Low / Median / High Price $93.56 / $128.04 / $230.26	Professional	26	$93.56	$128.04	$230.26
United Facility/Professional Professional Modifier TC Low / Median / High Price $71.90 / $144.55 / $245.52	Professional	TC	$71.90	$144.55	$245.52
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $127.54 / $153.24 / $172.67	Professional		$127.54	$153.24	$172.67
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $65.43 / $77.62 / $84.00	Professional	26	$65.43	$77.62	$84.00
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $62.12 / $75.61 / $88.67	Professional	TC	$62.12	$75.61	$88.67