Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $102.06 / $136.55 / $216.74	Facility	26	$102.06	$136.55	$216.74
Aetna Facility/Professional Professional Modifier Low / Median / High Price $125.40 / $169.00 / $350.30	Professional		$125.40	$169.00	$350.30
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $70.06 / $85.13 / $182.58	Professional	26	$70.06	$85.13	$182.58
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $53.95 / $68.64 / $135.19	Professional	TC	$53.95	$68.64	$135.19
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $167.52 / $243.26 / $380.04	Professional		$167.52	$243.26	$380.04
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $70.68 / $94.73 / $140.71	Professional	26	$70.68	$94.73	$140.71
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $106.02 / $351.19 / $351.19	Facility	26	$106.02	$351.19	$351.19
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $147.96 / $275.37 / $1,140.98	Professional		$147.96	$275.37	$1,140.98
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $91.50 / $159.66 / $644.85	Professional	26	$91.50	$159.66	$644.85
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $68.33 / $117.64 / $496.13	Professional	TC	$68.33	$117.64	$496.13
Cigna Facility/Professional Professional Modifier Low / Median / High Price $117.60 / $230.88 / $409.08	Professional		$117.60	$230.88	$409.08
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $83.21 / $139.87 / $233.65	Professional	26	$83.21	$139.87	$233.65
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $65.06 / $110.21 / $177.67	Professional	TC	$65.06	$110.21	$177.67
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $71.30 / $118.72 / $202.51	Facility	26	$71.30	$118.72	$202.51
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $127.44 / $204.30 / $352.37	Professional		$127.44	$204.30	$352.37
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $68.31 / $110.94 / $192.27	Professional	26	$68.31	$110.94	$192.27
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $57.04 / $93.84 / $160.91	Professional	TC	$57.04	$93.84	$160.91
Molina Facility/Professional Professional Modifier Low / Median / High Price $29.70 / $151.14 / $306.83	Professional		$29.70	$151.14	$306.83
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $111.72 / $153.52 / $155.44	Facility	26	$111.72	$153.52	$155.44
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $92.86 / $131.10 / $181.70	Professional	26	$92.86	$131.10	$181.70
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $75.42 / $108.77 / $141.94	Professional	TC	$75.42	$108.77	$141.94
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $105.55 / $105.55 / $106.02	Facility	26	$105.55	$105.55	$106.02
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $189.10 / $298.54 / $371.07	Professional		$189.10	$298.54	$371.07
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $109.40 / $172.86 / $210.45	Professional	26	$109.40	$172.86	$210.45
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $79.97 / $127.83 / $159.34	Professional	TC	$79.97	$127.83	$159.34
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $513.03 / $513.03 / $838.61	Facility	26	$513.03	$513.03	$838.61
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $188.03 / $264.18 / $355.97	Professional		$188.03	$264.18	$355.97
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $107.65 / $150.91 / $203.49	Professional	26	$107.65	$150.91	$203.49
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $80.39 / $111.23 / $152.69	Professional	TC	$80.39	$111.23	$152.69
United Facility/Professional Professional Modifier Low / Median / High Price $166.50 / $238.38 / $401.70	Professional		$166.50	$238.38	$401.70
United Facility/Professional Professional Modifier 26 Low / Median / High Price $94.76 / $132.24 / $227.71	Professional	26	$94.76	$132.24	$227.71
United Facility/Professional Professional Modifier TC Low / Median / High Price $71.89 / $107.96 / $177.44	Professional	TC	$71.89	$107.96	$177.44
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $109.60 / $131.49 / $147.37	Professional		$109.60	$131.49	$147.37
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $64.04 / $76.06 / $82.37	Professional	26	$64.04	$76.06	$82.37
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $45.55 / $55.43 / $64.98	Professional	TC	$45.55	$55.43	$64.98