Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $34.00 / $43.05 / $70.62	Facility	26	$34.00	$43.05	$70.62
Aetna Facility/Professional Professional Modifier Low / Median / High Price $102.94 / $149.43 / $480.00	Professional		$102.94	$149.43	$480.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $24.80 / $34.93 / $119.00	Professional	26	$24.80	$34.93	$119.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $77.34 / $112.83 / $242.55	Professional	TC	$77.34	$112.83	$242.55
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $180.12 / $194.72 / $268.52	Professional		$180.12	$194.72	$268.52
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $31.93 / $42.14 / $47.68	Professional	26	$31.93	$42.14	$47.68
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $136.01 / $136.01 / $136.01	Professional	TC	$136.01	$136.01	$136.01
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $57.98 / $118.23 / $136.00	Facility	26	$57.98	$118.23	$136.00
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $137.00 / $247.96 / $853.20	Professional		$137.00	$247.96	$853.20
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $35.25 / $62.29 / $279.51	Professional	26	$35.25	$62.29	$279.51
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $104.69 / $186.81 / $651.60	Professional	TC	$104.69	$186.81	$651.60
Cigna Facility/Professional Professional Modifier Low / Median / High Price $125.78 / $190.47 / $321.83	Professional		$125.78	$190.47	$321.83
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $29.83 / $46.13 / $80.22	Professional	26	$29.83	$46.13	$80.22
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $94.60 / $144.47 / $249.30	Professional	TC	$94.60	$144.47	$249.30
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $28.88 / $52.92 / $87.87	Facility	26	$28.88	$52.92	$87.87
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $104.47 / $210.64 / $278.86	Professional		$104.47	$210.64	$278.86
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $28.47 / $51.31 / $69.64	Professional	26	$28.47	$51.31	$69.64
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $80.59 / $159.72 / $215.15	Professional	TC	$80.59	$159.72	$215.15
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 $39.20 / $48.26 / $49.64	Facility	26	$39.20	$48.26	$49.64
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $29.20 / $41.61 / $55.66	Professional	26	$29.20	$41.61	$55.66
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $98.39 / $142.13 / $193.20	Professional	TC	$98.39	$142.13	$193.20
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $33.07 / $33.07 / $33.36	Facility	26	$33.07	$33.07	$33.36
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $151.56 / $225.64 / $277.44	Professional		$151.56	$225.64	$277.44
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $37.63 / $55.55 / $68.42	Professional	26	$37.63	$55.55	$68.42
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $113.93 / $169.99 / $209.02	Professional	TC	$113.93	$169.99	$209.02
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $446.45 / $446.45 / $782.93	Facility	26	$446.45	$446.45	$782.93
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $135.83 / $194.59 / $262.11	Professional		$135.83	$194.59	$262.11
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $33.72 / $47.99 / $64.64	Professional	26	$33.72	$47.99	$64.64
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $102.10 / $146.32 / $197.47	Professional	TC	$102.10	$146.32	$197.47
United Facility/Professional Professional Modifier Low / Median / High Price $116.07 / $168.48 / $283.86	Professional		$116.07	$168.48	$283.86
United Facility/Professional Professional Modifier 26 Low / Median / High Price $28.47 / $43.81 / $72.28	Professional	26	$28.47	$43.81	$72.28
United Facility/Professional Professional Modifier TC Low / Median / High Price $86.51 / $125.54 / $224.20	Professional	TC	$86.51	$125.54	$224.20
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $111.72 / $111.72 / $111.72	Professional		$111.72	$111.72	$111.72
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $25.54 / $25.54 / $25.54	Professional	26	$25.54	$25.54	$25.54
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $86.19 / $86.19 / $86.19	Professional	TC	$86.19	$86.19	$86.19