Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $43.07 / $68.88 / $89.19	Facility	26	$43.07	$68.88	$89.19
Aetna Facility/Professional Professional Modifier Low / Median / High Price $51.82 / $81.66 / $150.38	Professional		$51.82	$81.66	$150.38
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $32.50 / $43.07 / $82.77	Professional	26	$32.50	$43.07	$82.77
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $19.32 / $38.54 / $67.03	Professional	TC	$19.32	$38.54	$67.03
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $103.82 / $124.12 / $137.72	Professional		$103.82	$124.12	$137.72
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $37.20 / $37.20 / $49.52	Professional	26	$37.20	$37.20	$49.52
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $62.89 / $80.00 / $145.80	Facility	26	$62.89	$80.00	$145.80
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $87.94 / $154.46 / $572.40	Professional		$87.94	$154.46	$572.40
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $42.50 / $70.00 / $250.95	Professional	26	$42.50	$70.00	$250.95
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $43.21 / $82.92 / $321.45	Professional	TC	$43.21	$82.92	$321.45
Cigna Facility/Professional Professional Modifier Low / Median / High Price $59.59 / $111.07 / $230.74	Professional		$59.59	$111.07	$230.74
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $34.52 / $57.95 / $100.74	Professional	26	$34.52	$57.95	$100.74
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $21.61 / $58.83 / $129.05	Professional	TC	$21.61	$58.83	$129.05
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $29.76 / $43.20 / $85.94	Facility	26	$29.76	$43.20	$85.94
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $46.72 / $70.08 / $133.16	Professional		$46.72	$70.08	$133.16
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $28.84 / $43.06 / $79.15	Professional	26	$28.84	$43.06	$79.15
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $16.43 / $25.46 / $50.27	Professional	TC	$16.43	$25.46	$50.27
Molina Facility/Professional Professional Modifier Low / Median / High Price $14.95 / $61.89 / $145.42	Professional		$14.95	$61.89	$145.42
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $50.05 / $60.93 / $62.56	Facility	26	$50.05	$60.93	$62.56
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $39.56 / $50.50 / $67.67	Professional	26	$39.56	$50.50	$67.67
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $24.00 / $31.01 / $60.50	Professional	TC	$24.00	$31.01	$60.50
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $41.59 / $41.68 / $41.68	Facility	26	$41.59	$41.68	$41.68
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $100.40 / $151.49 / $184.87	Professional		$100.40	$151.49	$184.87
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $47.27 / $68.84 / $82.55	Professional	26	$47.27	$68.84	$82.55
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $54.95 / $80.43 / $101.09	Professional	TC	$54.95	$80.43	$101.09
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $72.06 / $72.06 / $127.19	Facility	26	$72.06	$72.06	$127.19
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $84.68 / $119.54 / $168.49	Professional		$84.68	$119.54	$168.49
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $42.50 / $57.20 / $76.36	Professional	26	$42.50	$57.20	$76.36
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $45.14 / $65.54 / $90.73	Professional	TC	$45.14	$65.54	$90.73
United Facility/Professional Professional Modifier Low / Median / High Price $65.36 / $91.15 / $184.54	Professional		$65.36	$91.15	$184.54
United Facility/Professional Professional Modifier 26 Low / Median / High Price $38.13 / $53.01 / $88.84	Professional	26	$38.13	$53.01	$88.84
United Facility/Professional Professional Modifier TC Low / Median / High Price $24.38 / $42.39 / $97.25	Professional	TC	$24.38	$42.39	$97.25
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $54.94 / $74.45 / $74.45	Professional		$54.94	$74.45	$74.45
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $25.40 / $32.35 / $32.35	Professional	26	$25.40	$32.35	$32.35
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $29.54 / $42.11 / $42.11	Professional	TC	$29.54	$42.11	$42.11