Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $35.27 / $46.12 / $90.54	Facility	26	$35.27	$46.12	$90.54
Aetna Facility/Professional Professional Modifier Low / Median / High Price $82.59 / $134.43 / $465.00	Professional		$82.59	$134.43	$465.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $28.58 / $47.88 / $143.00	Professional	26	$28.58	$47.88	$143.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $51.88 / $67.39 / $145.50	Professional	TC	$51.88	$67.39	$145.50
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $64.33 / $128.66 / $168.91	Professional		$64.33	$128.66	$168.91
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $25.52 / $49.55 / $60.06	Professional	26	$25.52	$49.55	$60.06
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $42.83 / $93.20 / $109.30	Professional	TC	$42.83	$93.20	$109.30
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $72.90 / $139.28 / $139.28	Facility	26	$72.90	$139.28	$139.28
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $112.73 / $205.63 / $695.85	Professional		$112.73	$205.63	$695.85
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $42.60 / $77.55 / $252.15	Professional	26	$42.60	$77.55	$252.15
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $70.83 / $129.69 / $443.70	Professional	TC	$70.83	$129.69	$443.70
Cigna Facility/Professional Professional Modifier Low / Median / High Price $94.73 / $155.82 / $260.48	Professional		$94.73	$155.82	$260.48
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $34.00 / $56.51 / $94.18	Professional	26	$34.00	$56.51	$94.18
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $62.22 / $98.53 / $166.42	Professional	TC	$62.22	$98.53	$166.42
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $30.38 / $65.37 / $110.07	Facility	26	$30.38	$65.37	$110.07
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $84.32 / $170.41 / $231.46	Professional		$84.32	$170.41	$231.46
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $30.38 / $64.45 / $81.88	Professional	26	$30.38	$64.45	$81.88
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $56.11 / $108.75 / $151.54	Professional	TC	$56.11	$108.75	$151.54
Molina Facility/Professional Professional Modifier Low / Median / High Price $12.75 / $69.49 / $221.26	Professional		$12.75	$69.49	$221.26
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $50.05 / $60.70 / $62.98	Facility	26	$50.05	$60.70	$62.98
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $37.20 / $54.60 / $68.62	Professional	26	$37.20	$54.60	$68.62
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $62.16 / $92.29 / $116.92	Professional	TC	$62.16	$92.29	$116.92
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $41.59 / $41.59 / $41.68	Facility	26	$41.59	$41.59	$41.68
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $126.30 / $186.42 / $227.76	Professional		$126.30	$186.42	$227.76
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $47.94 / $70.76 / $85.29	Professional	26	$47.94	$70.76	$85.29
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $78.36 / $115.87 / $142.47	Professional	TC	$78.36	$115.87	$142.47
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 $112.73 / $162.21 / $218.26	Professional		$112.73	$162.21	$218.26
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $42.50 / $61.58 / $81.92	Professional	26	$42.50	$61.58	$81.92
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $70.22 / $101.10 / $136.12	Professional	TC	$70.22	$101.10	$136.12
United Facility/Professional Professional Modifier Low / Median / High Price $85.53 / $94.08 / $248.54	Professional		$85.53	$94.08	$248.54
United Facility/Professional Professional Modifier 26 Low / Median / High Price $31.52 / $34.83 / $88.36	Professional	26	$31.52	$34.83	$88.36
United Facility/Professional Professional Modifier TC Low / Median / High Price $52.33 / $58.07 / $141.22	Professional	TC	$52.33	$58.07	$141.22
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $91.30 / $91.30 / $91.30	Professional		$91.30	$91.30	$91.30
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $32.22 / $32.22 / $32.22	Professional	26	$32.22	$32.22	$32.22
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $59.08 / $59.08 / $59.08	Professional	TC	$59.08	$59.08	$59.08