Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $40.65 / $49.61 / $104.88	Facility	26	$40.65	$49.61	$104.88
Aetna Facility/Professional Professional Modifier Low / Median / High Price $88.95 / $155.38 / $505.00	Professional		$88.95	$155.38	$505.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $32.13 / $55.14 / $154.00	Professional	26	$32.13	$55.14	$154.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $56.82 / $74.22 / $166.18	Professional	TC	$56.82	$74.22	$166.18
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $75.59 / $140.06 / $195.05	Professional		$75.59	$140.06	$195.05
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $26.81 / $57.14 / $64.06	Professional	26	$26.81	$57.14	$64.06
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $56.78 / $56.78 / $105.04	Professional	TC	$56.78	$56.78	$105.04
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $84.15 / $163.00 / $163.00	Facility	26	$84.15	$163.00	$163.00
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $128.90 / $233.16 / $795.23	Professional		$128.90	$233.16	$795.23
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $49.43 / $88.92 / $293.33	Professional	26	$49.43	$88.92	$293.33
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $79.45 / $144.08 / $501.90	Professional	TC	$79.45	$144.08	$501.90
Cigna Facility/Professional Professional Modifier Low / Median / High Price $105.86 / $174.94 / $298.08	Professional		$105.86	$174.94	$298.08
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $39.45 / $65.34 / $109.66	Professional	26	$39.45	$65.34	$109.66
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $66.87 / $108.97 / $188.35	Professional	TC	$66.87	$108.97	$188.35
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $39.39 / $76.56 / $130.10	Facility	26	$39.39	$76.56	$130.10
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $95.48 / $196.47 / $261.45	Professional		$95.48	$196.47	$261.45
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $39.39 / $75.92 / $95.09	Professional	26	$39.39	$75.92	$95.09
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $62.00 / $123.97 / $173.06	Professional	TC	$62.00	$123.97	$173.06
Molina Facility/Professional Professional Modifier Low / Median / High Price $21.22 / $100.68 / $228.14	Professional		$21.22	$100.68	$228.14
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $53.41 / $70.04 / $73.03	Facility	26	$53.41	$70.04	$73.03
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $43.82 / $61.56 / $77.04	Professional	26	$43.82	$61.56	$77.04
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $67.94 / $99.76 / $126.57	Professional	TC	$67.94	$99.76	$126.57
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $48.44 / $48.44 / $48.47	Facility	26	$48.44	$48.44	$48.47
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $143.82 / $212.29 / $260.57	Professional		$143.82	$212.29	$260.57
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $55.16 / $81.42 / $99.35	Professional	26	$55.16	$81.42	$99.35
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $88.67 / $131.12 / $161.22	Professional	TC	$88.67	$131.12	$161.22
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 $128.90 / $184.73 / $249.70	Professional		$128.90	$184.73	$249.70
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $49.43 / $71.17 / $95.21	Professional	26	$49.43	$71.17	$95.21
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $79.45 / $114.40 / $154.49	Professional	TC	$79.45	$114.40	$154.49
United Facility/Professional Professional Modifier Low / Median / High Price $97.44 / $110.04 / $265.06	Professional		$97.44	$110.04	$265.06
United Facility/Professional Professional Modifier 26 Low / Median / High Price $37.15 / $42.34 / $101.65	Professional	26	$37.15	$42.34	$101.65
United Facility/Professional Professional Modifier TC Low / Median / High Price $59.19 / $65.87 / $156.82	Professional	TC	$59.19	$65.87	$156.82
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $103.75 / $103.75 / $103.75	Professional		$103.75	$103.75	$103.75
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $37.18 / $37.18 / $37.18	Professional	26	$37.18	$37.18	$37.18
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $66.56 / $66.56 / $66.56	Professional	TC	$66.56	$66.56	$66.56