Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $16.80 / $27.89 / $55.71	Facility	26	$16.80	$27.89	$55.71
Aetna Facility/Professional Professional Modifier Low / Median / High Price $51.49 / $71.84 / $156.29	Professional		$51.49	$71.84	$156.29
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $13.49 / $16.80 / $44.31	Professional	26	$13.49	$16.80	$44.31
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $37.11 / $51.60 / $108.49	Professional	TC	$37.11	$51.60	$108.49
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $48.65 / $102.32 / $102.32	Professional		$48.65	$102.32	$102.32
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $8.43 / $24.17 / $25.99	Professional	26	$8.43	$24.17	$25.99
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $50.00 / $70.00 / $70.00	Facility	26	$50.00	$70.00	$70.00
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $84.55 / $146.51 / $537.29	Professional		$84.55	$146.51	$537.29
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $20.57 / $36.13 / $125.63	Professional	26	$20.57	$36.13	$125.63
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $64.22 / $107.29 / $411.68	Professional	TC	$64.22	$107.29	$411.68
Cigna Facility/Professional Professional Modifier Low / Median / High Price $56.33 / $103.09 / $201.46	Professional		$56.33	$103.09	$201.46
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $16.37 / $27.95 / $45.59	Professional	26	$16.37	$27.95	$45.59
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $41.40 / $74.95 / $156.94	Professional	TC	$41.40	$74.95	$156.94
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $15.19 / $34.11 / $290.81	Facility	26	$15.19	$34.11	$290.81
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $56.00 / $116.72 / $162.91	Professional		$56.00	$116.72	$162.91
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $15.19 / $32.39 / $41.16	Professional	26	$15.19	$32.39	$41.16
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $40.67 / $85.10 / $126.32	Professional	TC	$40.67	$85.10	$126.32
Molina Facility/Professional Professional Modifier Low / Median / High Price $15.02 / $73.02 / $159.79	Professional		$15.02	$73.02	$159.79
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $24.73 / $29.56 / $30.82	Facility	26	$24.73	$29.56	$30.82
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $19.78 / $24.75 / $31.95	Professional	26	$19.78	$24.75	$31.95
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $54.24 / $77.55 / $94.47	Professional	TC	$54.24	$77.55	$94.47
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $19.93 / $19.93 / $20.57	Facility	26	$19.93	$19.93	$20.57
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $94.06 / $141.79 / $174.34	Professional		$94.06	$141.79	$174.34
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $23.23 / $34.54 / $42.83	Professional	26	$23.23	$34.54	$42.83
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $70.38 / $107.48 / $132.16	Professional	TC	$70.38	$107.48	$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 $84.55 / $127.41 / $167.07	Professional		$84.55	$127.41	$167.07
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $21.12 / $30.83 / $42.31	Professional	26	$21.12	$30.83	$42.31
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $64.22 / $96.59 / $130.90	Professional	TC	$64.22	$96.59	$130.90
United Facility/Professional Professional Modifier Low / Median / High Price $57.35 / $69.33 / $169.58	Professional		$57.35	$69.33	$169.58
United Facility/Professional Professional Modifier 26 Low / Median / High Price $16.23 / $17.98 / $42.16	Professional	26	$16.23	$17.98	$42.16
United Facility/Professional Professional Modifier TC Low / Median / High Price $40.74 / $52.55 / $122.13	Professional	TC	$40.74	$52.55	$122.13
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $71.27 / $71.27 / $71.27	Professional		$71.27	$71.27	$71.27
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $15.75 / $15.75 / $15.75	Professional	26	$15.75	$15.75	$15.75
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $55.52 / $55.52 / $55.52	Professional	TC	$55.52	$55.52	$55.52