Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $35.75 / $48.21 / $79.08	Facility	26	$35.75	$48.21	$79.08
Aetna Facility/Professional Professional Modifier Low / Median / High Price $57.31 / $70.37 / $157.87	Professional		$57.31	$70.37	$157.87
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $25.30 / $30.82 / $64.48	Professional	26	$25.30	$30.82	$64.48
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $30.85 / $37.79 / $81.75	Professional	TC	$30.85	$37.79	$81.75
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $59.13 / $125.94 / $125.94	Professional		$59.13	$125.94	$125.94
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $38.86 / $42.32 / $47.87	Professional	26	$38.86	$42.32	$47.87
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $55.34 / $110.83 / $122.62	Facility	26	$55.34	$110.83	$122.62
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $74.33 / $130.72 / $717.26	Professional		$74.33	$130.72	$717.26
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $33.33 / $58.08 / $330.63	Professional	26	$33.33	$58.08	$330.63
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $42.22 / $74.00 / $563.89	Professional	TC	$42.22	$74.00	$563.89
Cigna Facility/Professional Professional Modifier Low / Median / High Price $63.29 / $104.96 / $194.85	Professional		$63.29	$104.96	$194.85
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $29.21 / $48.37 / $82.30	Professional	26	$29.21	$48.37	$82.30
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $34.22 / $57.10 / $112.55	Professional	TC	$34.22	$57.10	$112.55
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $26.32 / $43.05 / $77.11	Facility	26	$26.32	$43.05	$77.11
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $54.13 / $88.09 / $148.93	Professional		$54.13	$88.09	$148.93
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $25.42 / $40.97 / $67.76	Professional	26	$25.42	$40.97	$67.76
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $28.84 / $48.27 / $82.76	Professional	TC	$28.84	$48.27	$82.76
Molina Facility/Professional Professional Modifier Low / Median / High Price $14.89 / $66.43 / $151.62	Professional		$14.89	$66.43	$151.62
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $41.16 / $53.61 / $55.27	Facility	26	$41.16	$53.61	$55.27
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $39.70 / $52.93 / $55.70	Professional		$39.70	$52.93	$55.70
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $34.44 / $49.20 / $58.22	Professional	26	$34.44	$49.20	$58.22
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $39.22 / $52.80 / $64.68	Professional	TC	$39.22	$52.80	$64.68
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $37.02 / $37.15 / $37.15	Facility	26	$37.02	$37.15	$37.15
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $87.36 / $138.47 / $171.44	Professional		$87.36	$138.47	$171.44
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $38.10 / $61.63 / $73.77	Professional	26	$38.10	$61.63	$73.77
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $49.36 / $76.84 / $97.97	Professional	TC	$49.36	$76.84	$97.97
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $513.03 / $513.03 / $838.61	Facility	26	$513.03	$513.03	$838.61
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $84.08 / $118.30 / $155.88	Professional		$84.08	$118.30	$155.88
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $37.88 / $52.69 / $69.11	Professional	26	$37.88	$52.69	$69.11
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $46.20 / $65.83 / $83.86	Professional	TC	$46.20	$65.83	$83.86
United Facility/Professional Professional Modifier Low / Median / High Price $60.27 / $89.50 / $165.33	Professional		$60.27	$89.50	$165.33
United Facility/Professional Professional Modifier 26 Low / Median / High Price $28.85 / $44.55 / $78.20	Professional	26	$28.85	$44.55	$78.20
United Facility/Professional Professional Modifier TC Low / Median / High Price $31.04 / $47.49 / $85.15	Professional	TC	$31.04	$47.49	$85.15
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $52.45 / $71.06 / $71.06	Professional		$52.45	$71.06	$71.06
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $22.36 / $28.29 / $28.29	Professional	26	$22.36	$28.29	$28.29
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $30.09 / $42.78 / $42.78	Professional	TC	$30.09	$42.78	$42.78