Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $42.56 / $83.45 / $137.69	Facility	26	$42.56	$83.45	$137.69
Aetna Facility/Professional Professional Modifier Low / Median / High Price $83.20 / $101.64 / $371.00	Professional		$83.20	$101.64	$371.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $36.17 / $50.56 / $130.08	Professional	26	$36.17	$50.56	$130.08
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $40.65 / $61.85 / $192.00	Professional	TC	$40.65	$61.85	$192.00
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $147.28 / $147.28 / $164.08	Professional		$147.28	$147.28	$164.08
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $29.76 / $62.72 / $72.52	Professional	26	$29.76	$62.72	$72.52
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $51.18 / $169.56 / $169.56	Facility	26	$51.18	$169.56	$169.56
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $98.87 / $181.42 / $1,002.61	Professional		$98.87	$181.42	$1,002.61
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $51.74 / $91.77 / $312.23	Professional	26	$51.74	$91.77	$312.23
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $51.65 / $95.57 / $780.59	Professional	TC	$51.65	$95.57	$780.59
Cigna Facility/Professional Professional Modifier Low / Median / High Price $83.83 / $149.24 / $252.08	Professional		$83.83	$149.24	$252.08
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $40.29 / $68.20 / $113.40	Professional	26	$40.29	$68.20	$113.40
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $36.97 / $78.90 / $136.08	Professional	TC	$36.97	$78.90	$136.08
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $36.89 / $78.81 / $104.29	Facility	26	$36.89	$78.81	$104.29
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $75.64 / $154.59 / $246.10	Professional		$75.64	$154.59	$246.10
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $36.89 / $79.56 / $102.90	Professional	26	$36.89	$79.56	$102.90
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $37.77 / $73.64 / $148.69	Professional	TC	$37.77	$73.64	$148.69
Molina Facility/Professional Professional Modifier Low / Median / High Price $14.06 / $70.67 / $222.67	Professional		$14.06	$70.67	$222.67
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $61.55 / $73.81 / $76.38	Facility	26	$61.55	$73.81	$76.38
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $45.02 / $68.40 / $80.37	Professional	26	$45.02	$68.40	$80.37
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $41.36 / $65.93 / $103.18	Professional	TC	$41.36	$65.93	$103.18
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $50.74 / $50.74 / $51.18	Facility	26	$50.74	$50.74	$51.18
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $117.18 / $178.38 / $219.33	Professional		$117.18	$178.38	$219.33
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $57.81 / $87.91 / $106.60	Professional	26	$57.81	$87.91	$106.60
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $59.36 / $87.50 / $116.14	Professional	TC	$59.36	$87.50	$116.14
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $98.87 / $152.80 / $210.18	Professional		$98.87	$152.80	$210.18
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $53.76 / $77.50 / $104.60	Professional	26	$53.76	$77.50	$104.60
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $47.12 / $79.34 / $108.23	Professional	TC	$47.12	$79.34	$108.23
United Facility/Professional Professional Modifier Low / Median / High Price $62.27 / $96.87 / $213.23	Professional		$62.27	$96.87	$213.23
United Facility/Professional Professional Modifier 26 Low / Median / High Price $34.65 / $48.94 / $111.67	Professional	26	$34.65	$48.94	$111.67
United Facility/Professional Professional Modifier TC Low / Median / High Price $27.61 / $55.62 / $116.67	Professional	TC	$27.61	$55.62	$116.67
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $88.69 / $88.69 / $88.69	Professional		$88.69	$88.69	$88.69
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $39.20 / $39.20 / $39.20	Professional	26	$39.20	$39.20	$39.20
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $49.49 / $49.49 / $49.49	Professional	TC	$49.49	$49.49	$49.49