Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $53.54 / $80.31 / $137.72	Facility	26	$53.54	$80.31	$137.72
Aetna Facility/Professional Professional Modifier Low / Median / High Price $158.59 / $255.01 / $512.71	Professional		$158.59	$255.01	$512.71
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $44.99 / $59.42 / $142.50	Professional	26	$44.99	$59.42	$142.50
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $103.68 / $192.00 / $306.32	Professional	TC	$103.68	$192.00	$306.32
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $102.80 / $245.14 / $275.95	Professional		$102.80	$245.14	$275.95
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $50.52 / $78.48 / $84.58	Professional	26	$50.52	$78.48	$84.58
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $58.80 / $68.30 / $68.30	Professional	TC	$58.80	$68.30	$68.30
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $442.24 / $442.24 / $442.24	Facility	26	$442.24	$442.24	$442.24
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $185.26 / $320.44 / $1,609.32	Professional		$185.26	$320.44	$1,609.32
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $65.14 / $116.69 / $388.43	Professional	26	$65.14	$116.69	$388.43
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $120.12 / $218.22 / $1,345.00	Professional	TC	$120.12	$218.22	$1,345.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $144.61 / $306.16 / $488.80	Professional		$144.61	$306.16	$488.80
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $47.19 / $86.49 / $154.12	Professional	26	$47.19	$86.49	$154.12
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $95.46 / $218.93 / $367.59	Professional	TC	$95.46	$218.93	$367.59
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $52.65 / $106.12 / $319.91	Facility	26	$52.65	$106.12	$319.91
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $178.35 / $351.71 / $626.37	Professional		$178.35	$351.71	$626.37
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $47.24 / $101.68 / $141.56	Professional	26	$47.24	$101.68	$141.56
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $138.82 / $252.10 / $493.72	Professional	TC	$138.82	$252.10	$493.72
Molina Facility/Professional Professional Modifier Low / Median / High Price $29.33 / $149.27 / $312.59	Professional		$29.33	$149.27	$312.59
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $76.95 / $92.51 / $95.88	Facility	26	$76.95	$92.51	$95.88
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $57.20 / $80.36 / $99.22	Professional	26	$57.20	$80.36	$99.22
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $142.15 / $220.09 / $290.39	Professional	TC	$142.15	$220.09	$290.39
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $63.87 / $63.87 / $63.98	Facility	26	$63.87	$63.87	$63.98
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $206.20 / $312.60 / $381.89	Professional		$206.20	$312.60	$381.89
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $72.17 / $110.10 / $131.97	Professional	26	$72.17	$110.10	$131.97
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $134.03 / $202.36 / $249.91	Professional	TC	$134.03	$202.36	$249.91
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 $185.26 / $274.72 / $407.52	Professional		$185.26	$274.72	$407.52
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $65.14 / $96.88 / $131.52	Professional	26	$65.14	$96.88	$131.52
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $120.12 / $177.84 / $274.48	Professional	TC	$120.12	$177.84	$274.48
United Facility/Professional Professional Modifier Low / Median / High Price $133.75 / $241.88 / $422.93	Professional		$133.75	$241.88	$422.93
United Facility/Professional Professional Modifier 26 Low / Median / High Price $43.56 / $63.47 / $134.28	Professional	26	$43.56	$63.47	$134.28
United Facility/Professional Professional Modifier TC Low / Median / High Price $90.19 / $161.75 / $290.54	Professional	TC	$90.19	$161.75	$290.54
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $149.16 / $149.16 / $149.16	Professional		$149.16	$149.16	$149.16
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $49.05 / $49.05 / $49.05	Professional	26	$49.05	$49.05	$49.05
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $100.12 / $100.12 / $100.12	Professional	TC	$100.12	$100.12	$100.12