Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $34.47 / $42.04 / $88.56	Facility	26	$34.47	$42.04	$88.56
Aetna Facility/Professional Professional Modifier Low / Median / High Price $102.63 / $138.40 / $593.08	Professional		$102.63	$138.40	$593.08
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $27.82 / $46.06 / $129.41	Professional	26	$27.82	$46.06	$129.41
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $71.76 / $95.69 / $180.49	Professional	TC	$71.76	$95.69	$180.49
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $78.25 / $187.67 / $227.48	Professional		$78.25	$187.67	$227.48
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $23.88 / $48.44 / $54.32	Professional	26	$23.88	$48.44	$54.32
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $129.80 / $152.13 / $164.48	Professional	TC	$129.80	$152.13	$164.48
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $71.41 / $136.22 / $136.22	Facility	26	$71.41	$136.22	$136.22
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $140.44 / $259.80 / $862.05	Professional		$140.44	$259.80	$862.05
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $42.04 / $75.94 / $246.60	Professional	26	$42.04	$75.94	$246.60
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $98.41 / $178.77 / $615.45	Professional	TC	$98.41	$178.77	$615.45
Cigna Facility/Professional Professional Modifier Low / Median / High Price $89.96 / $192.40 / $322.95	Professional		$89.96	$192.40	$322.95
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $33.46 / $55.55 / $92.11	Professional	26	$33.46	$55.55	$92.11
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $49.32 / $136.83 / $231.11	Professional	TC	$49.32	$136.83	$231.11
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $34.89 / $65.97 / $109.56	Facility	26	$34.89	$65.97	$109.56
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $97.00 / $160.53 / $291.20	Professional		$97.00	$160.53	$291.20
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $34.51 / $63.78 / $80.12	Professional	26	$34.51	$63.78	$80.12
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $52.44 / $100.05 / $216.01	Professional	TC	$52.44	$100.05	$216.01
Molina Facility/Professional Professional Modifier Low / Median / High Price $21.11 / $100.68 / $227.98	Professional		$21.11	$100.68	$227.98
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $48.95 / $59.37 / $61.64	Facility	26	$48.95	$59.37	$61.64
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $40.71 / $51.22 / $62.84	Professional	26	$40.71	$51.22	$62.84
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $48.96 / $88.58 / $148.18	Professional	TC	$48.96	$88.58	$148.18
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $40.67 / $40.67 / $41.22	Facility	26	$40.67	$40.67	$41.22
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $156.71 / $232.20 / $281.19	Professional		$156.71	$232.20	$281.19
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $46.91 / $69.23 / $83.42	Professional	26	$46.91	$69.23	$83.42
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $109.80 / $162.07 / $197.77	Professional	TC	$109.80	$162.07	$197.77
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 $140.44 / $198.15 / $269.45	Professional		$140.44	$198.15	$269.45
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $42.04 / $60.52 / $80.16	Professional	26	$42.04	$60.52	$80.16
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $98.41 / $141.03 / $189.52	Professional	TC	$98.41	$141.03	$189.52
United Facility/Professional Professional Modifier Low / Median / High Price $103.02 / $119.02 / $278.73	Professional		$103.02	$119.02	$278.73
United Facility/Professional Professional Modifier 26 Low / Median / High Price $31.31 / $33.92 / $84.74	Professional	26	$31.31	$33.92	$84.74
United Facility/Professional Professional Modifier TC Low / Median / High Price $72.18 / $85.17 / $203.59	Professional	TC	$72.18	$85.17	$203.59
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $113.74 / $113.74 / $113.74	Professional		$113.74	$113.74	$113.74
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $31.50 / $31.50 / $31.50	Professional	26	$31.50	$31.50	$31.50
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $82.24 / $82.24 / $82.24	Professional	TC	$82.24	$82.24	$82.24