Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $31.78 / $50.84 / $93.47	Facility	26	$31.78	$50.84	$93.47
Aetna Facility/Professional Professional Modifier Low / Median / High Price $98.26 / $125.00 / $246.24	Professional		$98.26	$125.00	$246.24
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $26.35 / $31.78 / $68.03	Professional	26	$26.35	$31.78	$68.03
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $71.34 / $88.96 / $156.13	Professional	TC	$71.34	$88.96	$156.13
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $133.85 / $197.53 / $242.26	Professional		$133.85	$197.53	$242.26
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $15.81 / $47.06 / $51.30	Professional	26	$15.81	$47.06	$51.30
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $38.51 / $128.65 / $128.65	Facility	26	$38.51	$128.65	$128.65
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $144.61 / $256.82 / $901.13	Professional		$144.61	$256.82	$901.13
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $39.27 / $68.92 / $233.33	Professional	26	$39.27	$68.92	$233.33
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $105.34 / $184.54 / $667.88	Professional	TC	$105.34	$184.54	$667.88
Cigna Facility/Professional Professional Modifier Low / Median / High Price $116.17 / $192.10 / $339.92	Professional		$116.17	$192.10	$339.92
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $31.32 / $51.94 / $86.99	Professional	26	$31.32	$51.94	$86.99
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $85.15 / $141.66 / $254.61	Professional	TC	$85.15	$141.66	$254.61
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $32.24 / $59.28 / $78.45	Facility	26	$32.24	$59.28	$78.45
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $116.06 / $213.43 / $286.89	Professional		$116.06	$213.43	$286.89
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $32.24 / $59.75 / $75.94	Professional	26	$32.24	$59.75	$75.94
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $83.82 / $155.36 / $211.79	Professional	TC	$83.82	$155.36	$211.79
Molina Facility/Professional Professional Modifier Low / Median / High Price $21.52 / $108.82 / $293.91	Professional		$21.52	$108.82	$293.91
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $46.20 / $56.02 / $56.28	Facility	26	$46.20	$56.02	$56.28
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $78.25 / $78.25 / $86.94	Professional		$78.25	$78.25	$86.94
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $33.77 / $46.20 / $56.28	Professional	26	$33.77	$46.20	$56.28
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $124.49 / $140.54 / $153.43	Professional	TC	$124.49	$140.54	$153.43
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $38.39 / $38.39 / $38.51	Facility	26	$38.39	$38.39	$38.51
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $161.35 / $238.60 / $293.37	Professional		$161.35	$238.60	$293.37
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $43.82 / $64.68 / $78.73	Professional	26	$43.82	$64.68	$78.73
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $117.53 / $174.57 / $214.64	Professional	TC	$117.53	$174.57	$214.64
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $211.40 / $211.40 / $379.18	Facility	26	$211.40	$211.40	$379.18
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $144.61 / $206.74 / $277.16	Professional		$144.61	$206.74	$277.16
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $39.27 / $56.28 / $75.45	Professional	26	$39.27	$56.28	$75.45
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $105.34 / $151.13 / $203.88	Professional	TC	$105.34	$151.13	$203.88
United Facility/Professional Professional Modifier Low / Median / High Price $108.85 / $120.06 / $285.37	Professional		$108.85	$120.06	$285.37
United Facility/Professional Professional Modifier 26 Low / Median / High Price $30.30 / $33.35 / $86.22	Professional	26	$30.30	$33.35	$86.22
United Facility/Professional Professional Modifier TC Low / Median / High Price $78.42 / $86.88 / $216.62	Professional	TC	$78.42	$86.88	$216.62
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $121.13 / $121.13 / $121.13	Professional		$121.13	$121.13	$121.13
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $29.81 / $29.81 / $29.81	Professional	26	$29.81	$29.81	$29.81
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $91.32 / $91.32 / $91.32	Professional	TC	$91.32	$91.32	$91.32