Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $46.03 / $69.17 / $132.93	Facility	26	$46.03	$69.17	$132.93
Aetna Facility/Professional Professional Modifier Low / Median / High Price $93.75 / $178.76 / $576.00	Professional		$93.75	$178.76	$576.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $36.61 / $56.24 / $219.00	Professional	26	$36.61	$56.24	$219.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $56.82 / $89.94 / $195.63	Professional	TC	$56.82	$89.94	$195.63
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $86.56 / $170.13 / $216.38	Professional		$86.56	$170.13	$216.38
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $39.31 / $64.86 / $72.72	Professional	26	$39.31	$64.86	$72.72
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $68.89 / $127.45 / $149.44	Professional	TC	$68.89	$127.45	$149.44
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $95.69 / $181.68 / $181.68	Facility	26	$95.69	$181.68	$181.68
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $152.00 / $281.58 / $942.90	Professional		$152.00	$281.58	$942.90
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $55.90 / $100.72 / $330.30	Professional	26	$55.90	$100.72	$330.30
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $95.97 / $174.20 / $612.53	Professional	TC	$95.97	$174.20	$612.53
Cigna Facility/Professional Professional Modifier Low / Median / High Price $121.31 / $203.25 / $354.95	Professional		$121.31	$203.25	$354.95
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $44.77 / $74.55 / $123.97	Professional	26	$44.77	$74.55	$123.97
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $74.76 / $129.94 / $230.01	Professional	TC	$74.76	$129.94	$230.01
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $40.92 / $87.28 / $148.26	Facility	26	$40.92	$87.28	$148.26
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $113.46 / $231.57 / $303.75	Professional		$113.46	$231.57	$303.75
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $40.92 / $87.18 / $110.06	Professional	26	$40.92	$87.18	$110.06
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $72.84 / $145.52 / $203.78	Professional	TC	$72.84	$145.52	$203.78
Molina Facility/Professional Professional Modifier Low / Median / High Price $21.43 / $100.68 / $228.14	Professional		$21.43	$100.68	$228.14
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $61.05 / $79.61 / $84.32	Facility	26	$61.05	$79.61	$84.32
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $55.80 / $70.62 / $90.00	Professional	26	$55.80	$70.62	$90.00
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $94.47 / $120.55 / $151.11	Professional	TC	$94.47	$120.55	$151.11
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $54.81 / $54.81 / $54.84	Facility	26	$54.81	$54.81	$54.84
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $169.60 / $251.56 / $309.31	Professional		$169.60	$251.56	$309.31
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $61.94 / $91.48 / $112.48	Professional	26	$61.94	$91.48	$112.48
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $107.74 / $160.08 / $196.83	Professional	TC	$107.74	$160.08	$196.83
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 $152.00 / $217.83 / $296.41	Professional		$152.00	$217.83	$296.41
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $55.90 / $79.81 / $107.78	Professional	26	$55.90	$79.81	$107.78
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $96.10 / $138.69 / $188.54	Professional	TC	$96.10	$138.69	$188.54
United Facility/Professional Professional Modifier Low / Median / High Price $111.49 / $122.64 / $299.95	Professional		$111.49	$122.64	$299.95
United Facility/Professional Professional Modifier 26 Low / Median / High Price $42.20 / $47.40 / $113.99	Professional	26	$42.20	$47.40	$113.99
United Facility/Professional Professional Modifier TC Low / Median / High Price $69.31 / $77.91 / $190.56	Professional	TC	$69.31	$77.91	$190.56
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $123.03 / $123.03 / $123.03	Professional		$123.03	$123.03	$123.03
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $42.25 / $42.25 / $42.25	Professional	26	$42.25	$42.25	$42.25
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $80.78 / $80.78 / $80.78	Professional	TC	$80.78	$80.78	$80.78