Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $57.47 / $91.97 / $117.18	Facility	26	$57.47	$91.97	$117.18
Aetna Facility/Professional Professional Modifier Low / Median / High Price $66.40 / $105.73 / $245.62	Professional		$66.40	$105.73	$245.62
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $42.25 / $57.47 / $117.45	Professional	26	$42.25	$57.47	$117.45
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $23.28 / $43.86 / $75.75	Professional	TC	$23.28	$43.86	$75.75
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $155.68 / $155.68 / $155.68	Professional		$155.68	$155.68	$155.68
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $79.14 / $79.14 / $79.14	Professional	26	$79.14	$79.14	$79.14
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $72.06 / $95.51 / $190.77	Facility	26	$72.06	$95.51	$190.77
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $108.31 / $183.44 / $673.35	Professional		$108.31	$183.44	$673.35
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $56.45 / $92.73 / $331.58	Professional	26	$56.45	$92.73	$331.58
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $46.09 / $88.89 / $341.78	Professional	TC	$46.09	$88.89	$341.78
Cigna Facility/Professional Professional Modifier Low / Median / High Price $74.58 / $140.53 / $271.06	Professional		$74.58	$140.53	$271.06
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $45.72 / $76.38 / $132.75	Professional	26	$45.72	$76.38	$132.75
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $23.42 / $63.24 / $138.31	Professional	TC	$23.42	$63.24	$138.31
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $38.72 / $58.08 / $106.54	Facility	26	$38.72	$58.08	$106.54
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $57.97 / $86.36 / $167.68	Professional		$57.97	$86.36	$167.68
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $38.72 / $56.87 / $103.13	Professional	26	$38.72	$56.87	$103.13
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $18.29 / $28.96 / $59.24	Professional	TC	$18.29	$28.96	$59.24
Molina Facility/Professional Professional Modifier Low / Median / High Price $14.95 / $61.98 / $145.42	Professional		$14.95	$61.98	$145.42
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $66.00 / $80.04 / $83.64	Facility	26	$66.00	$80.04	$83.64
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $50.82 / $69.48 / $89.54	Professional	26	$50.82	$69.48	$89.54
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $26.13 / $35.56 / $58.56	Professional	TC	$26.13	$35.56	$58.56
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $54.84 / $55.72 / $55.72	Facility	26	$54.84	$55.72	$55.72
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $118.38 / $180.67 / $214.98	Professional		$118.38	$180.67	$214.98
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $63.10 / $91.48 / $108.93	Professional	26	$63.10	$91.48	$108.93
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $58.44 / $85.55 / $106.13	Professional	TC	$58.44	$85.55	$106.13
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 $105.56 / $143.62 / $200.86	Professional		$105.56	$143.62	$200.86
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $56.83 / $75.59 / $102.09	Professional	26	$56.83	$75.59	$102.09
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $48.40 / $70.76 / $96.50	Professional	TC	$48.40	$70.76	$96.50
United Facility/Professional Professional Modifier Low / Median / High Price $79.04 / $109.98 / $220.64	Professional		$79.04	$109.98	$220.64
United Facility/Professional Professional Modifier 26 Low / Median / High Price $50.02 / $69.44 / $120.78	Professional	26	$50.02	$69.44	$120.78
United Facility/Professional Professional Modifier TC Low / Median / High Price $27.84 / $49.02 / $104.28	Professional	TC	$27.84	$49.02	$104.28
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $64.87 / $87.40 / $87.40	Professional		$64.87	$87.40	$87.40
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $33.40 / $42.53 / $42.53	Professional	26	$33.40	$42.53	$42.53
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $31.48 / $44.87 / $44.87	Professional	TC	$31.48	$44.87	$44.87