Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $31.41 / $49.31 / $99.18	Facility	26	$31.41	$49.31	$99.18
Aetna Facility/Professional Professional Modifier Low / Median / High Price $64.58 / $112.65 / $337.88	Professional		$64.58	$112.65	$337.88
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $25.26 / $31.41 / $83.90	Professional	26	$25.26	$31.41	$83.90
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $33.61 / $75.81 / $128.65	Professional	TC	$33.61	$75.81	$128.65
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $43.30 / $50.31 / $99.50	Professional		$43.30	$50.31	$99.50
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $15.26 / $29.44 / $47.32	Professional	26	$15.26	$29.44	$47.32
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $64.91 / $124.11 / $124.11	Facility	26	$64.91	$124.11	$124.11
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $83.80 / $151.51 / $562.97	Professional		$83.80	$151.51	$562.97
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $37.94 / $69.11 / $224.85	Professional	26	$37.94	$69.11	$224.85
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $50.87 / $86.78 / $399.92	Professional	TC	$50.87	$86.78	$399.92
Cigna Facility/Professional Professional Modifier Low / Median / High Price $70.39 / $122.84 / $204.88	Professional		$70.39	$122.84	$204.88
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $30.48 / $50.73 / $83.15	Professional	26	$30.48	$50.73	$83.15
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $37.40 / $69.11 / $128.09	Professional	TC	$37.40	$69.11	$128.09
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $31.98 / $59.45 / $98.14	Facility	26	$31.98	$59.45	$98.14
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $83.00 / $137.36 / $245.28	Professional		$83.00	$137.36	$245.28
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $31.10 / $57.64 / $72.56	Professional	26	$31.10	$57.64	$72.56
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $42.77 / $78.61 / $187.32	Professional	TC	$42.77	$78.61	$187.32
Molina Facility/Professional Professional Modifier Low / Median / High Price $12.62 / $65.14 / $147.48	Professional		$12.62	$65.14	$147.48
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $44.55 / $54.03 / $55.02	Facility	26	$44.55	$54.03	$55.02
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $54.27 / $56.90 / $61.76	Professional		$54.27	$56.90	$61.76
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $32.96 / $46.74 / $59.49	Professional	26	$32.96	$46.74	$59.49
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $37.35 / $56.28 / $136.96	Professional	TC	$37.35	$56.28	$136.96
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $37.02 / $37.02 / $37.15	Facility	26	$37.02	$37.02	$37.15
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $91.24 / $136.44 / $167.78	Professional		$91.24	$136.44	$167.78
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $42.33 / $62.39 / $75.92	Professional	26	$42.33	$62.39	$75.92
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $48.97 / $74.70 / $93.30	Professional	TC	$48.97	$74.70	$93.30
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $211.40 / $211.40 / $385.75	Facility	26	$211.40	$211.40	$385.75
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $79.93 / $117.68 / $158.50	Professional		$79.93	$117.68	$158.50
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $37.88 / $54.54 / $73.11	Professional	26	$37.88	$54.54	$73.11
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $42.04 / $64.43 / $86.78	Professional	TC	$42.04	$64.43	$86.78
United Facility/Professional Professional Modifier Low / Median / High Price $59.91 / $83.87 / $164.06	Professional		$59.91	$83.87	$164.06
United Facility/Professional Professional Modifier 26 Low / Median / High Price $28.90 / $31.01 / $74.77	Professional	26	$28.90	$31.01	$74.77
United Facility/Professional Professional Modifier TC Low / Median / High Price $30.32 / $49.92 / $90.24	Professional	TC	$30.32	$49.92	$90.24
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $68.03 / $68.03 / $68.03	Professional		$68.03	$68.03	$68.03
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $28.68 / $28.68 / $28.68	Professional	26	$28.68	$28.68	$28.68
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $39.34 / $39.34 / $39.34	Professional	TC	$39.34	$39.34	$39.34