Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $31.91 / $60.87 / $111.90	Facility	26	$31.91	$60.87	$111.90
Aetna Facility/Professional Professional Modifier Low / Median / High Price $62.40 / $90.49 / $533.91	Professional		$62.40	$90.49	$533.91
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $28.73 / $52.05 / $596.66	Professional	26	$28.73	$52.05	$596.66
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $35.04 / $44.02 / $83.38	Professional	TC	$35.04	$44.02	$83.38
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $53.00 / $59.79 / $175.09	Professional		$53.00	$59.79	$175.09
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $27.55 / $34.36 / $65.05	Professional	26	$27.55	$34.36	$65.05
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $43.04 / $170.00 / $246.13	Facility	26	$43.04	$170.00	$246.13
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $88.24 / $155.18 / $565.65	Professional		$88.24	$155.18	$565.65
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $43.89 / $74.56 / $378.10	Professional	26	$43.89	$74.56	$378.10
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $45.59 / $77.76 / $378.10	Professional	TC	$45.59	$77.76	$378.10
Cigna Facility/Professional Professional Modifier Low / Median / High Price $81.37 / $136.00 / $210.52	Professional		$81.37	$136.00	$210.52
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $40.09 / $64.78 / $103.45	Professional	26	$40.09	$64.78	$103.45
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $41.61 / $70.77 / $110.50	Professional	TC	$41.61	$70.77	$110.50
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $30.07 / $69.95 / $399.23	Facility	26	$30.07	$69.95	$399.23
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $65.41 / $146.93 / $189.20	Professional		$65.41	$146.93	$189.20
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $30.66 / $68.45 / $86.97	Professional	26	$30.66	$68.45	$86.97
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $35.03 / $76.53 / $101.32	Professional	TC	$35.03	$76.53	$101.32
Molina Facility/Professional Professional Modifier Low / Median / High Price $12.75 / $64.23 / $144.49	Professional		$12.75	$64.23	$144.49
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $45.08 / $61.64 / $64.98	Facility	26	$45.08	$61.64	$64.98
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $46.21 / $51.35 / $57.29	Professional		$46.21	$51.35	$57.29
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $38.19 / $57.29 / $69.00	Professional	26	$38.19	$57.29	$69.00
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $42.61 / $61.74 / $74.25	Professional	TC	$42.61	$61.74	$74.25
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $43.04 / $43.04 / $44.33	Facility	26	$43.04	$43.04	$44.33
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $101.55 / $150.94 / $180.65	Professional		$101.55	$150.94	$180.65
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $50.34 / $73.94 / $89.25	Professional	26	$50.34	$73.94	$89.25
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $51.03 / $76.98 / $91.62	Professional	TC	$51.03	$76.98	$91.62
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $246.13 / $246.13 / $422.45	Facility	26	$246.13	$246.13	$422.45
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $88.24 / $135.63 / $177.84	Professional		$88.24	$135.63	$177.84
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $43.89 / $66.44 / $87.13	Professional	26	$43.89	$66.44	$87.13
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $44.35 / $68.54 / $91.05	Professional	TC	$44.35	$68.54	$91.05
United Facility/Professional Professional Modifier Low / Median / High Price $81.42 / $89.26 / $170.65	Professional		$81.42	$89.26	$170.65
United Facility/Professional Professional Modifier 26 Low / Median / High Price $36.96 / $41.95 / $84.89	Professional	26	$36.96	$41.95	$84.89
United Facility/Professional Professional Modifier TC Low / Median / High Price $41.15 / $47.48 / $90.26	Professional	TC	$41.15	$47.48	$90.26
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $75.69 / $75.69 / $75.69	Professional		$75.69	$75.69	$75.69
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $35.15 / $35.15 / $35.15	Professional	26	$35.15	$35.15	$35.15
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $40.53 / $40.53 / $40.53	Professional	TC	$40.53	$40.53	$40.53