Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $32.57 / $45.21 / $63.91	Facility	26	$32.57	$45.21	$63.91
Aetna Facility/Professional Professional Modifier Low / Median / High Price $81.68 / $107.62 / $270.49	Professional		$81.68	$107.62	$270.49
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $19.89 / $32.58 / $64.84	Professional	26	$19.89	$32.58	$64.84
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $61.40 / $76.95 / $175.51	Professional	TC	$61.40	$76.95	$175.51
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $22.18 / $47.60 / $76.95	Professional	26	$22.18	$47.60	$76.95
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $100.00 / $128.65 / $128.65	Facility	26	$100.00	$128.65	$128.65
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $124.95 / $240.93 / $839.78	Professional		$124.95	$240.93	$839.78
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $39.10 / $67.81 / $233.10	Professional	26	$39.10	$67.81	$233.10
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $95.06 / $168.61 / $606.67	Professional	TC	$95.06	$168.61	$606.67
Cigna Facility/Professional Professional Modifier Low / Median / High Price $87.75 / $161.88 / $314.67	Professional		$87.75	$161.88	$314.67
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $24.37 / $44.17 / $85.20	Professional	26	$24.37	$44.17	$85.20
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $63.72 / $121.82 / $231.69	Professional	TC	$63.72	$121.82	$231.69
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $27.06 / $50.75 / $490.69	Facility	26	$27.06	$50.75	$490.69
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $87.61 / $182.70 / $264.54	Professional		$87.61	$182.70	$264.54
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $24.76 / $48.52 / $69.73	Professional	26	$24.76	$48.52	$69.73
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $66.02 / $133.51 / $194.80	Professional	TC	$66.02	$133.51	$194.80
Molina Facility/Professional Professional Modifier Low / Median / High Price $21.52 / $102.70 / $228.88	Professional		$21.52	$102.70	$228.88
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $37.61 / $54.51 / $56.95	Facility	26	$37.61	$54.51	$56.95
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $29.40 / $42.24 / $56.28	Professional	26	$29.40	$42.24	$56.28
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $78.79 / $115.64 / $138.00	Professional	TC	$78.79	$115.64	$138.00
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 $147.08 / $227.51 / $277.06	Professional		$147.08	$227.51	$277.06
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $42.30 / $65.44 / $79.97	Professional	26	$42.30	$65.44	$79.97
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $104.77 / $162.07 / $196.56	Professional	TC	$104.77	$162.07	$196.56
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $346.39 / $346.39 / $851.78	Facility	26	$346.39	$346.39	$851.78
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $139.06 / $201.16 / $271.48	Professional		$139.06	$201.16	$271.48
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $39.27 / $58.13 / $78.83	Professional	26	$39.27	$58.13	$78.83
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $99.79 / $143.94 / $195.19	Professional	TC	$99.79	$143.94	$195.19
United Facility/Professional Professional Modifier Low / Median / High Price $89.15 / $111.45 / $267.81	Professional		$89.15	$111.45	$267.81
United Facility/Professional Professional Modifier 26 Low / Median / High Price $23.97 / $33.54 / $81.69	Professional	26	$23.97	$33.54	$81.69
United Facility/Professional Professional Modifier TC Low / Median / High Price $62.40 / $76.16 / $202.35	Professional	TC	$62.40	$76.16	$202.35
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $109.74 / $109.74 / $109.74	Professional		$109.74	$109.74	$109.74
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $29.75 / $29.75 / $29.75	Professional	26	$29.75	$29.75	$29.75
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $79.98 / $79.98 / $79.98	Professional	TC	$79.98	$79.98	$79.98