Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $24.28 / $35.90 / $50.43	Facility	26	$24.28	$35.90	$50.43
Aetna Facility/Professional Professional Modifier Low / Median / High Price $58.31 / $83.60 / $216.00	Professional		$58.31	$83.60	$216.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $18.21 / $25.62 / $79.00	Professional	26	$18.21	$25.62	$79.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $37.68 / $53.98 / $97.65	Professional	TC	$37.68	$53.98	$97.65
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $48.78 / $106.75 / $141.78	Professional		$48.78	$106.75	$141.78
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $17.82 / $29.17 / $31.47	Professional	26	$17.82	$29.17	$31.47
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $41.47 / $128.36 / $128.36	Facility	26	$41.47	$128.36	$128.36
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $74.00 / $128.97 / $604.11	Professional		$74.00	$128.97	$604.11
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $25.11 / $45.10 / $456.30	Professional	26	$25.11	$45.10	$456.30
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $46.83 / $82.27 / $388.70	Professional	TC	$46.83	$82.27	$388.70
Cigna Facility/Professional Professional Modifier Low / Median / High Price $64.53 / $99.52 / $167.21	Professional		$64.53	$99.52	$167.21
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $21.36 / $33.11 / $57.55	Professional	26	$21.36	$33.11	$57.55
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $42.91 / $70.48 / $118.15	Professional	TC	$42.91	$70.48	$118.15
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $17.52 / $35.58 / $49.38	Facility	26	$17.52	$35.58	$49.38
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $54.53 / $108.11 / $172.02	Professional		$54.53	$108.11	$172.02
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $17.52 / $36.27 / $49.38	Professional	26	$17.52	$36.27	$49.38
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $36.27 / $71.84 / $121.52	Professional	TC	$36.27	$71.84	$121.52
Molina Facility/Professional Professional Modifier Low / Median / High Price $9.15 / $53.27 / $92.54	Professional		$9.15	$53.27	$92.54
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $27.93 / $34.47 / $35.88	Facility	26	$27.93	$34.47	$35.88
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $23.71 / $30.68 / $39.26	Professional	26	$23.71	$30.68	$39.26
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $45.03 / $60.60 / $79.23	Professional	TC	$45.03	$60.60	$79.23
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $23.56 / $23.56 / $23.76	Facility	26	$23.56	$23.56	$23.76
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $77.95 / $115.87 / $142.47	Professional		$77.95	$115.87	$142.47
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $26.81 / $39.64 / $48.74	Professional	26	$26.81	$39.64	$48.74
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $51.03 / $76.23 / $95.20	Professional	TC	$51.03	$76.23	$95.20
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $70.69 / $99.92 / $136.53	Professional		$70.69	$99.92	$136.53
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $24.02 / $34.18 / $46.05	Professional	26	$24.02	$34.18	$46.05
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $46.66 / $65.73 / $89.82	Professional	TC	$46.66	$65.73	$89.82
United Facility/Professional Professional Modifier Low / Median / High Price $61.02 / $101.15 / $159.16	Professional		$61.02	$101.15	$159.16
United Facility/Professional Professional Modifier 26 Low / Median / High Price $21.62 / $32.14 / $52.31	Professional	26	$21.62	$32.14	$52.31
United Facility/Professional Professional Modifier TC Low / Median / High Price $38.61 / $66.45 / $99.45	Professional	TC	$38.61	$66.45	$99.45
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $56.78 / $56.78 / $56.78	Professional		$56.78	$56.78	$56.78
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $18.23 / $18.23 / $18.23	Professional	26	$18.23	$18.23	$18.23
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $38.54 / $38.54 / $38.54	Professional	TC	$38.54	$38.54	$38.54