Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $57.37 / $77.66 / $121.47	Facility	26	$57.37	$77.66	$121.47
Aetna Facility/Professional Professional Modifier Low / Median / High Price $70.98 / $86.17 / $142.41	Professional		$70.98	$86.17	$142.41
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $38.81 / $45.98 / $77.00	Professional	26	$38.81	$45.98	$77.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $33.78 / $41.64 / $74.48	Professional	TC	$33.78	$41.64	$74.48
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $65.68 / $65.68 / $77.28	Professional		$65.68	$65.68	$77.28
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $59.41 / $196.79 / $196.79	Facility	26	$59.41	$196.79	$196.79
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $102.33 / $182.00 / $747.83	Professional		$102.33	$182.00	$747.83
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $50.00 / $91.98 / $359.40	Professional	26	$50.00	$91.98	$359.40
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $42.41 / $91.11 / $388.35	Professional	TC	$42.41	$91.11	$388.35
Cigna Facility/Professional Professional Modifier Low / Median / High Price $82.95 / $145.97 / $268.04	Professional		$82.95	$145.97	$268.04
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $44.90 / $78.11 / $130.76	Professional	26	$44.90	$78.11	$130.76
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $35.11 / $74.25 / $137.28	Professional	TC	$35.11	$74.25	$137.28
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $38.08 / $63.28 / $112.62	Facility	26	$38.08	$63.28	$112.62
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $66.64 / $111.13 / $209.55	Professional		$66.64	$111.13	$209.55
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $37.86 / $60.12 / $106.70	Professional	26	$37.86	$60.12	$106.70
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $30.52 / $53.47 / $103.81	Professional	TC	$30.52	$53.47	$103.81
Molina Facility/Professional Professional Modifier Low / Median / High Price $20.34 / $69.78 / $221.99	Professional		$20.34	$69.78	$221.99
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $63.21 / $86.04 / $87.10	Facility	26	$63.21	$86.04	$87.10
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $58.82 / $75.52 / $90.46	Professional	26	$58.82	$75.52	$90.46
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $46.80 / $61.71 / $87.62	Professional	TC	$46.80	$61.71	$87.62
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $59.34 / $59.34 / $59.41	Facility	26	$59.34	$59.34	$59.41
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $123.61 / $195.31 / $238.57	Professional		$123.61	$195.31	$238.57
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $62.04 / $98.03 / $119.30	Professional	26	$62.04	$98.03	$119.30
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $61.57 / $97.28 / $120.64	Professional	TC	$61.57	$97.28	$120.64
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $270.73 / $270.73 / $459.43	Facility	26	$270.73	$270.73	$459.43
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $121.97 / $171.08 / $229.68	Professional		$121.97	$171.08	$229.68
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $60.52 / $84.56 / $115.12	Professional	26	$60.52	$84.56	$115.12
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $61.45 / $85.33 / $114.52	Professional	TC	$61.45	$85.33	$114.52
United Facility/Professional Professional Modifier Low / Median / High Price $91.10 / $142.13 / $247.96	Professional		$91.10	$142.13	$247.96
United Facility/Professional Professional Modifier 26 Low / Median / High Price $54.19 / $74.83 / $127.50	Professional	26	$54.19	$74.83	$127.50
United Facility/Professional Professional Modifier TC Low / Median / High Price $40.20 / $68.34 / $123.52	Professional	TC	$40.20	$68.34	$123.52
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $71.50 / $85.86 / $96.58	Professional		$71.50	$85.86	$96.58
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $35.89 / $42.54 / $45.79	Professional	26	$35.89	$42.54	$45.79
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $35.61 / $43.32 / $50.79	Professional	TC	$35.61	$43.32	$50.79