Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $37.53 / $60.06 / $93.03	Facility	26	$37.53	$60.06	$93.03
Aetna Facility/Professional Professional Modifier Low / Median / High Price $70.89 / $91.78 / $189.32	Professional		$70.89	$91.78	$189.32
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $28.89 / $36.63 / $81.67	Professional	26	$28.89	$36.63	$81.67
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $42.92 / $53.82 / $102.20	Professional	TC	$42.92	$53.82	$102.20
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $18.48 / $53.21 / $54.81	Professional	26	$18.48	$53.21	$54.81
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $44.85 / $149.85 / $149.85	Facility	26	$44.85	$149.85	$149.85
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $112.88 / $198.69 / $707.48	Professional		$112.88	$198.69	$707.48
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $45.74 / $80.70 / $272.55	Professional	26	$45.74	$80.70	$272.55
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $71.61 / $117.81 / $434.93	Professional	TC	$71.61	$117.81	$434.93
Cigna Facility/Professional Professional Modifier Low / Median / High Price $82.44 / $149.83 / $262.52	Professional		$82.44	$149.83	$262.52
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $35.52 / $60.40 / $99.28	Professional	26	$35.52	$60.40	$99.28
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $46.92 / $86.88 / $163.13	Professional	TC	$46.92	$86.88	$163.13
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $39.39 / $69.70 / $91.37	Facility	26	$39.39	$69.70	$91.37
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $85.79 / $175.23 / $234.03	Professional		$85.79	$175.23	$234.03
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $36.45 / $73.26 / $90.89	Professional	26	$36.45	$73.26	$90.89
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $49.70 / $102.35 / $138.71	Professional	TC	$49.70	$102.35	$138.71
Molina Facility/Professional Professional Modifier Low / Median / High Price $13.48 / $70.94 / $222.87	Professional		$13.48	$70.94	$222.87
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $53.90 / $65.14 / $66.33	Facility	26	$53.90	$65.14	$66.33
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $39.40 / $53.90 / $69.29	Professional	26	$39.40	$53.90	$69.29
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $79.73 / $95.56 / $99.83	Professional	TC	$79.73	$95.56	$99.83
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $44.79 / $44.79 / $44.85	Facility	26	$44.79	$44.79	$44.85
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $128.94 / $191.18 / $233.06	Professional		$128.94	$191.18	$233.06
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $51.10 / $75.84 / $93.30	Professional	26	$51.10	$75.84	$93.30
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $78.08 / $117.17 / $140.40	Professional	TC	$78.08	$117.17	$140.40
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $117.35 / $169.20 / $231.78	Professional		$117.35	$169.20	$231.78
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $45.74 / $67.81 / $91.96	Professional	26	$45.74	$67.81	$91.96
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $71.61 / $103.07 / $139.82	Professional	TC	$71.61	$103.07	$139.82
United Facility/Professional Professional Modifier Low / Median / High Price $83.67 / $96.81 / $229.28	Professional		$83.67	$96.81	$229.28
United Facility/Professional Professional Modifier 26 Low / Median / High Price $35.71 / $39.10 / $92.76	Professional	26	$35.71	$39.10	$92.76
United Facility/Professional Professional Modifier TC Low / Median / High Price $47.96 / $56.66 / $131.66	Professional	TC	$47.96	$56.66	$131.66
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $91.69 / $91.69 / $91.69	Professional		$91.69	$91.69	$91.69
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $34.59 / $34.59 / $34.59	Professional	26	$34.59	$34.59	$34.59
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $57.10 / $57.10 / $57.10	Professional	TC	$57.10	$57.10	$57.10