Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $137.15 / $181.46 / $289.11	Facility	26	$137.15	$181.46	$289.11
Aetna Facility/Professional Professional Modifier Low / Median / High Price $164.19 / $205.98 / $462.44	Professional		$164.19	$205.98	$462.44
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $93.61 / $120.29 / $244.17	Professional	26	$93.61	$120.29	$244.17
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $69.26 / $88.59 / $176.59	Professional	TC	$69.26	$88.59	$176.59
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $168.52 / $317.92 / $499.22	Professional		$168.52	$317.92	$499.22
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $94.22 / $180.94 / $202.87	Professional	26	$94.22	$180.94	$202.87
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $141.21 / $467.77 / $467.77	Facility	26	$141.21	$467.77	$467.77
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $193.23 / $360.10 / $1,488.83	Professional		$193.23	$360.10	$1,488.83
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $122.13 / $212.56 / $858.83	Professional	26	$122.13	$212.56	$858.83
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $86.79 / $149.47 / $630.00	Professional	TC	$86.79	$149.47	$630.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $153.27 / $303.94 / $534.15	Professional		$153.27	$303.94	$534.15
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $110.59 / $186.28 / $311.16	Professional	26	$110.59	$186.28	$311.16
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $83.89 / $140.07 / $225.81	Professional	TC	$83.89	$140.07	$225.81
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $95.17 / $158.60 / $270.33	Facility	26	$95.17	$158.60	$270.33
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $167.58 / $266.85 / $463.28	Professional		$167.58	$266.85	$463.28
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $91.28 / $147.41 / $256.88	Professional	26	$91.28	$147.41	$256.88
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $73.78 / $121.38 / $206.75	Professional	TC	$73.78	$121.38	$206.75
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 $162.71 / $204.40 / $207.03	Facility	26	$162.71	$204.40	$207.03
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $120.20 / $173.42 / $214.75	Professional	26	$120.20	$173.42	$214.75
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $91.17 / $129.80 / $161.28	Professional	TC	$91.17	$129.80	$161.28
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $140.88 / $140.88 / $141.21	Facility	26	$140.88	$140.88	$141.21
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $247.22 / $390.61 / $487.97	Professional		$247.22	$390.61	$487.97
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $145.40 / $229.73 / $280.29	Professional	26	$145.40	$229.73	$280.29
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $101.82 / $163.59 / $202.46	Professional	TC	$101.82	$163.59	$202.46
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 $245.78 / $345.14 / $464.89	Professional		$245.78	$345.14	$464.89
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $143.68 / $201.00 / $273.62	Professional	26	$143.68	$201.00	$273.62
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $102.10 / $142.00 / $196.08	Professional	TC	$102.10	$142.00	$196.08
United Facility/Professional Professional Modifier Low / Median / High Price $205.96 / $319.19 / $535.64	Professional		$205.96	$319.19	$535.64
United Facility/Professional Professional Modifier 26 Low / Median / High Price $128.94 / $179.95 / $308.83	Professional	26	$128.94	$179.95	$308.83
United Facility/Professional Professional Modifier TC Low / Median / High Price $91.26 / $136.88 / $225.34	Professional	TC	$91.26	$136.88	$225.34
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $143.28 / $171.85 / $192.41	Professional		$143.28	$171.85	$192.41
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $85.30 / $101.28 / $109.66	Professional	26	$85.30	$101.28	$109.66
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $57.98 / $70.56 / $82.75	Professional	TC	$57.98	$70.56	$82.75