Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $45.61 / $60.56 / $117.56	Facility	26	$45.61	$60.56	$117.56
Aetna Facility/Professional Professional Modifier Low / Median / High Price $130.80 / $208.62 / $412.62	Professional		$130.80	$208.62	$412.62
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $37.83 / $51.88 / $123.00	Professional	26	$37.83	$51.88	$123.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $82.92 / $160.87 / $285.00	Professional	TC	$82.92	$160.87	$285.00
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $84.98 / $202.03 / $202.60	Professional		$84.98	$202.03	$202.60
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $33.28 / $67.22 / $73.20	Professional	26	$33.28	$67.22	$73.20
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $127.45 / $127.45 / $127.45	Professional	TC	$127.45	$127.45	$127.45
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $376.16 / $376.16 / $376.16	Facility	26	$376.16	$376.16	$376.16
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $149.82 / $261.00 / $1,267.82	Professional		$149.82	$261.00	$1,267.82
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $54.98 / $99.29 / $329.85	Professional	26	$54.98	$99.29	$329.85
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $96.10 / $175.30 / $1,108.00	Professional	TC	$96.10	$175.30	$1,108.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $115.03 / $227.03 / $392.70	Professional		$115.03	$227.03	$392.70
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $40.04 / $73.02 / $126.53	Professional	26	$40.04	$73.02	$126.53
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $72.97 / $149.60 / $278.37	Professional	TC	$72.97	$149.60	$278.37
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $44.55 / $90.96 / $319.91	Facility	26	$44.55	$90.96	$319.91
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $140.05 / $255.19 / $494.40	Professional		$140.05	$255.19	$494.40
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $39.36 / $85.20 / $110.61	Professional	26	$39.36	$85.20	$110.61
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $88.69 / $172.94 / $378.85	Professional	TC	$88.69	$172.94	$378.85
Molina Facility/Professional Professional Modifier Low / Median / High Price $21.66 / $103.10 / $228.28	Professional		$21.66	$103.10	$228.28
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $65.45 / $79.15 / $81.73	Facility	26	$65.45	$79.15	$81.73
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $55.80 / $71.92 / $84.42	Professional	26	$55.80	$71.92	$84.42
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $96.61 / $130.53 / $260.49	Professional	TC	$96.61	$130.53	$260.49
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $53.91 / $53.91 / $54.38	Facility	26	$53.91	$53.91	$54.38
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $169.60 / $256.69 / $311.69	Professional		$169.60	$256.69	$311.69
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $61.64 / $92.11 / $112.32	Professional	26	$61.64	$92.11	$112.32
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $107.74 / $162.99 / $199.37	Professional	TC	$107.74	$162.99	$199.37
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $211.40 / $211.40 / $385.75	Facility	26	$211.40	$211.40	$385.75
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $151.07 / $224.97 / $307.25	Professional		$151.07	$224.97	$307.25
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $54.98 / $82.35 / $111.28	Professional	26	$54.98	$82.35	$111.28
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $96.10 / $143.24 / $195.87	Professional	TC	$96.10	$143.24	$195.87
United Facility/Professional Professional Modifier Low / Median / High Price $99.70 / $169.00 / $346.77	Professional		$99.70	$169.00	$346.77
United Facility/Professional Professional Modifier 26 Low / Median / High Price $37.11 / $46.56 / $113.99	Professional	26	$37.11	$46.56	$113.99
United Facility/Professional Professional Modifier TC Low / Median / High Price $62.58 / $121.80 / $220.30	Professional	TC	$62.58	$121.80	$220.30
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $122.79 / $122.79 / $122.79	Professional		$122.79	$122.79	$122.79
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $42.01 / $42.01 / $42.01	Professional	26	$42.01	$42.01	$42.01
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $80.78 / $80.78 / $80.78	Professional	TC	$80.78	$80.78	$80.78