Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $29.87 / $46.91 / $85.64	Facility	26	$29.87	$46.91	$85.64
Aetna Facility/Professional Professional Modifier Low / Median / High Price $86.06 / $129.86 / $343.83	Professional		$86.06	$129.86	$343.83
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $24.64 / $29.88 / $76.20	Professional	26	$24.64	$29.88	$76.20
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $61.40 / $93.68 / $185.06	Professional	TC	$61.40	$93.68	$185.06
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $83.47 / $165.59 / $292.73	Professional		$83.47	$165.59	$292.73
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $20.51 / $44.35 / $49.73	Professional	26	$20.51	$44.35	$49.73
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $177.19 / $177.19 / $177.19	Professional	TC	$177.19	$177.19	$177.19
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $35.33 / $116.58 / $116.58	Facility	26	$35.33	$116.58	$116.58
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $148.30 / $259.82 / $922.58	Professional		$148.30	$259.82	$922.58
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $36.15 / $64.50 / $213.98	Professional	26	$36.15	$64.50	$213.98
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $112.27 / $191.61 / $708.60	Professional	TC	$112.27	$191.61	$708.60
Cigna Facility/Professional Professional Modifier Low / Median / High Price $105.88 / $187.89 / $348.18	Professional		$105.88	$187.89	$348.18
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $29.12 / $48.28 / $79.75	Professional	26	$29.12	$48.28	$79.75
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $75.26 / $136.06 / $267.80	Professional	TC	$75.26	$136.06	$267.80
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $25.97 / $55.72 / $93.23	Facility	26	$25.97	$55.72	$93.23
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $93.31 / $189.02 / $279.39	Professional		$93.31	$189.02	$279.39
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $25.97 / $55.10 / $70.03	Professional	26	$25.97	$55.10	$70.03
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $67.58 / $133.91 / $213.51	Professional	TC	$67.58	$133.91	$213.51
Molina Facility/Professional Professional Modifier Low / Median / High Price $21.66 / $108.82 / $293.82	Professional		$21.66	$108.82	$293.82
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $42.31 / $50.69 / $52.93	Facility	26	$42.31	$50.69	$52.93
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $33.18 / $42.35 / $53.82	Professional	26	$33.18	$42.35	$53.82
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $88.36 / $133.65 / $162.81	Professional	TC	$88.36	$133.65	$162.81
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $35.19 / $35.19 / $35.33	Facility	26	$35.19	$35.19	$35.33
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $165.48 / $244.25 / $299.94	Professional		$165.48	$244.25	$299.94
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $40.26 / $59.35 / $72.17	Professional	26	$40.26	$59.35	$72.17
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $124.99 / $185.24 / $227.76	Professional	TC	$124.99	$185.24	$227.76
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 $148.30 / $211.59 / $283.64	Professional		$148.30	$211.59	$283.64
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $36.04 / $51.88 / $69.59	Professional	26	$36.04	$51.88	$69.59
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $112.27 / $160.88 / $215.18	Professional	TC	$112.27	$160.88	$215.18
United Facility/Professional Professional Modifier Low / Median / High Price $108.78 / $119.66 / $302.27	Professional		$108.78	$119.66	$302.27
United Facility/Professional Professional Modifier 26 Low / Median / High Price $28.15 / $30.81 / $73.45	Professional	26	$28.15	$30.81	$73.45
United Facility/Professional Professional Modifier TC Low / Median / High Price $80.79 / $90.59 / $228.82	Professional	TC	$80.79	$90.59	$228.82
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $122.66 / $122.66 / $122.66	Professional		$122.66	$122.66	$122.66
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $26.88 / $26.88 / $26.88	Professional	26	$26.88	$26.88	$26.88
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $95.78 / $95.78 / $95.78	Professional	TC	$95.78	$95.78	$95.78