Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $35.11 / $52.87 / $71.63	Facility	26	$35.11	$52.87	$71.63
Aetna Facility/Professional Professional Modifier Low / Median / High Price $44.45 / $71.45 / $186.00	Professional		$44.45	$71.45	$186.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $25.92 / $35.11 / $83.45	Professional	26	$25.92	$35.11	$83.45
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $17.87 / $37.15 / $64.81	Professional	TC	$17.87	$37.15	$64.81
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $48.38 / $48.38 / $48.38	Professional	26	$48.38	$48.38	$48.38
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $50.41 / $80.00 / $118.83	Facility	26	$50.41	$80.00	$118.83
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $77.34 / $138.47 / $511.65	Professional		$77.34	$138.47	$511.65
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $33.82 / $57.07 / $204.75	Professional	26	$33.82	$57.07	$204.75
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $41.34 / $79.93 / $306.89	Professional	TC	$41.34	$79.93	$306.89
Cigna Facility/Professional Professional Modifier Low / Median / High Price $50.78 / $98.80 / $205.91	Professional		$50.78	$98.80	$205.91
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $28.14 / $47.09 / $81.83	Professional	26	$28.14	$47.09	$81.83
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $19.86 / $56.63 / $123.08	Professional	TC	$19.86	$56.63	$123.08
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $23.36 / $35.03 / $70.83	Facility	26	$23.36	$35.03	$70.83
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $38.72 / $59.60 / $114.64	Professional		$38.72	$59.60	$114.64
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $23.36 / $35.03 / $64.75	Professional	26	$23.36	$35.03	$64.75
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $15.04 / $24.40 / $48.40	Professional	TC	$15.04	$24.40	$48.40
Molina Facility/Professional Professional Modifier Low / Median / High Price $14.54 / $61.89 / $145.42	Professional		$14.54	$61.89	$145.42
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $39.22 / $48.91 / $51.00	Facility	26	$39.22	$48.91	$51.00
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $29.75 / $43.07 / $57.38	Professional	26	$29.75	$43.07	$57.38
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $19.35 / $30.78 / $70.34	Professional	TC	$19.35	$30.78	$70.34
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $33.82 / $33.97 / $33.97	Facility	26	$33.82	$33.97	$33.97
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $89.41 / $135.79 / $162.37	Professional		$89.41	$135.79	$162.37
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $38.54 / $56.12 / $67.13	Professional	26	$38.54	$56.12	$67.13
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $52.45 / $76.92 / $95.25	Professional	TC	$52.45	$76.92	$95.25
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 $74.02 / $107.30 / $151.06	Professional		$74.02	$107.30	$151.06
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $34.65 / $46.10 / $62.25	Professional	26	$34.65	$46.10	$62.25
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $43.52 / $63.63 / $86.60	Professional	TC	$43.52	$63.63	$86.60
United Facility/Professional Professional Modifier Low / Median / High Price $57.04 / $80.29 / $165.48	Professional		$57.04	$80.29	$165.48
United Facility/Professional Professional Modifier 26 Low / Median / High Price $30.00 / $43.47 / $74.13	Professional	26	$30.00	$43.47	$74.13
United Facility/Professional Professional Modifier TC Low / Median / High Price $22.94 / $45.78 / $101.62	Professional	TC	$22.94	$45.78	$101.62
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $48.59 / $66.12 / $66.12	Professional		$48.59	$66.12	$66.12
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $20.43 / $25.99 / $25.99	Professional	26	$20.43	$25.99	$25.99
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $28.16 / $40.13 / $40.13	Professional	TC	$28.16	$40.13	$40.13