Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $31.41 / $51.65 / $99.18	Facility	26	$31.41	$51.65	$99.18
Aetna Facility/Professional Professional Modifier Low / Median / High Price $66.52 / $127.31 / $371.00	Professional		$66.52	$127.31	$371.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $24.79 / $33.29 / $86.00	Professional	26	$24.79	$33.29	$86.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $42.50 / $95.89 / $222.47	Professional	TC	$42.50	$95.89	$222.47
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $80.05 / $192.79 / $216.15	Professional		$80.05	$192.79	$216.15
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $21.39 / $47.32 / $74.23	Professional	26	$21.39	$47.32	$74.23
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $163.10 / $163.10 / $176.32	Professional	TC	$163.10	$163.10	$176.32
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $156.94 / $255.84 / $255.84	Facility	26	$156.94	$255.84	$255.84
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $140.30 / $244.60 / $885.15	Professional		$140.30	$244.60	$885.15
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $37.88 / $65.84 / $224.85	Professional	26	$37.88	$65.84	$224.85
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $94.16 / $174.00 / $660.30	Professional	TC	$94.16	$174.00	$660.30
Cigna Facility/Professional Professional Modifier Low / Median / High Price $96.60 / $187.35 / $345.04	Professional		$96.60	$187.35	$345.04
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $27.17 / $49.38 / $86.05	Professional	26	$27.17	$49.38	$86.05
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $68.52 / $135.51 / $252.67	Professional	TC	$68.52	$135.51	$252.67
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $29.64 / $60.76 / $236.39	Facility	26	$29.64	$60.76	$236.39
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $105.09 / $204.12 / $291.66	Professional		$105.09	$204.12	$291.66
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $26.66 / $57.64 / $75.68	Professional	26	$26.66	$57.64	$75.68
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $76.68 / $143.26 / $215.20	Professional	TC	$76.68	$143.26	$215.20
Molina Facility/Professional Professional Modifier Low / Median / High Price $21.52 / $103.73 / $228.30	Professional		$21.52	$103.73	$228.30
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $44.55 / $54.03 / $54.94	Facility	26	$44.55	$54.03	$54.94
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $32.79 / $45.82 / $57.81	Professional	26	$32.79	$45.82	$57.81
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $87.64 / $124.26 / $151.41	Professional	TC	$87.64	$124.26	$151.41
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $37.02 / $37.02 / $37.15	Facility	26	$37.02	$37.02	$37.15
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $155.25 / $237.62 / $289.22	Professional		$155.25	$237.62	$289.22
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $42.64 / $63.15 / $77.11	Professional	26	$42.64	$63.15	$77.11
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $115.89 / $174.92 / $211.83	Professional	TC	$115.89	$174.92	$211.83
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $156.94 / $156.94 / $209.36	Facility	26	$156.94	$156.94	$209.36
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $141.37 / $210.30 / $276.00	Professional		$141.37	$210.30	$276.00
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $37.88 / $56.05 / $75.42	Professional	26	$37.88	$56.05	$75.42
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $103.49 / $155.28 / $210.94	Professional	TC	$103.49	$155.28	$210.94
United Facility/Professional Professional Modifier Low / Median / High Price $90.49 / $111.78 / $293.55	Professional		$90.49	$111.78	$293.55
United Facility/Professional Professional Modifier 26 Low / Median / High Price $24.96 / $30.91 / $78.95	Professional	26	$24.96	$30.91	$78.95
United Facility/Professional Professional Modifier TC Low / Median / High Price $65.34 / $87.00 / $207.48	Professional	TC	$65.34	$87.00	$207.48
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $116.84 / $116.84 / $116.84	Professional		$116.84	$116.84	$116.84
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $28.68 / $28.68 / $28.68	Professional	26	$28.68	$28.68	$28.68
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $88.16 / $88.16 / $88.16	Professional	TC	$88.16	$88.16	$88.16