Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $16.44 / $27.27 / $45.28	Facility	26	$16.44	$27.27	$45.28
Aetna Facility/Professional Professional Modifier Low / Median / High Price $59.94 / $80.73 / $178.20	Professional		$59.94	$80.73	$178.20
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $13.62 / $17.91 / $38.61	Professional	26	$13.62	$17.91	$38.61
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $43.72 / $61.03 / $117.00	Professional	TC	$43.72	$61.03	$117.00
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $48.13 / $114.72 / $130.50	Professional		$48.13	$114.72	$130.50
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $14.04 / $23.64 / $28.51	Professional	26	$14.04	$23.64	$28.51
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $100.00 / $126.00 / $126.00	Facility	26	$100.00	$126.00	$126.00
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $83.80 / $149.16 / $531.75	Professional		$83.80	$149.16	$531.75
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $19.87 / $35.72 / $151.90	Professional	26	$19.87	$35.72	$151.90
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $65.59 / $114.89 / $411.68	Professional	TC	$65.59	$114.89	$411.68
Cigna Facility/Professional Professional Modifier Low / Median / High Price $66.63 / $115.01 / $199.39	Professional		$66.63	$115.01	$199.39
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $16.48 / $28.13 / $43.84	Professional	26	$16.48	$28.13	$43.84
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $48.38 / $87.71 / $156.94	Professional	TC	$48.38	$87.71	$156.94
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $16.27 / $33.97 / $290.81	Facility	26	$16.27	$33.97	$290.81
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $61.01 / $128.31 / $174.85	Professional		$61.01	$128.31	$174.85
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $15.64 / $33.04 / $43.87	Professional	26	$15.64	$33.04	$43.87
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $45.68 / $96.72 / $130.02	Professional	TC	$45.68	$96.72	$130.02
Molina Facility/Professional Professional Modifier Low / Median / High Price $15.00 / $72.92 / $159.77	Professional		$15.00	$72.92	$159.77
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $23.65 / $28.81 / $32.83	Facility	26	$23.65	$28.81	$32.83
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $18.89 / $27.37 / $34.78	Professional	26	$18.89	$27.37	$34.78
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $54.27 / $79.65 / $95.70	Professional	TC	$54.27	$79.65	$95.70
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $19.48 / $19.48 / $19.64	Facility	26	$19.48	$19.48	$19.64
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $95.88 / $142.41 / $172.46	Professional		$95.88	$142.41	$172.46
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $22.68 / $33.75 / $40.94	Professional	26	$22.68	$33.75	$40.94
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $73.20 / $109.13 / $132.16	Professional	TC	$73.20	$109.13	$132.16
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $211.40 / $211.40 / $385.75	Facility	26	$211.40	$211.40	$385.75
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $85.47 / $126.04 / $166.86	Professional		$85.47	$126.04	$166.86
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $20.64 / $29.76 / $43.23	Professional	26	$20.64	$29.76	$43.23
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $67.31 / $97.57 / $132.31	Professional	TC	$67.31	$97.57	$132.31
United Facility/Professional Professional Modifier Low / Median / High Price $60.27 / $72.95 / $165.04	Professional		$60.27	$72.95	$165.04
United Facility/Professional Professional Modifier 26 Low / Median / High Price $15.52 / $18.39 / $41.80	Professional	26	$15.52	$18.39	$41.80
United Facility/Professional Professional Modifier TC Low / Median / High Price $44.75 / $53.70 / $129.46	Professional	TC	$44.75	$53.70	$129.46
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $70.54 / $70.54 / $70.54	Professional		$70.54	$70.54	$70.54
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $15.41 / $15.41 / $15.41	Professional	26	$15.41	$15.41	$15.41
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $55.13 / $55.13 / $55.13	Professional	TC	$55.13	$55.13	$55.13