Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $37.53 / $40.90 / $93.03	Facility	26	$37.53	$40.90	$93.03
Aetna Facility/Professional Professional Modifier Low / Median / High Price $97.02 / $122.84 / $272.82	Professional		$97.02	$122.84	$272.82
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $28.89 / $37.31 / $73.63	Professional	26	$28.89	$37.31	$73.63
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $68.13 / $84.05 / $158.44	Professional	TC	$68.13	$84.05	$158.44
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $201.70 / $201.70 / $215.72	Professional		$201.70	$201.70	$215.72
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $31.53 / $57.07 / $58.05	Professional	26	$31.53	$57.07	$58.05
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $68.88 / $149.85 / $149.85	Facility	26	$68.88	$149.85	$149.85
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $143.94 / $264.67 / $946.20	Professional		$143.94	$264.67	$946.20
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $45.74 / $80.09 / $272.55	Professional	26	$45.74	$80.09	$272.55
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $110.88 / $186.68 / $673.65	Professional	TC	$110.88	$186.68	$673.65
Cigna Facility/Professional Professional Modifier Low / Median / High Price $108.53 / $198.02 / $353.99	Professional		$108.53	$198.02	$353.99
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $35.52 / $60.40 / $99.28	Professional	26	$35.52	$60.40	$99.28
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $73.01 / $134.87 / $253.04	Professional	TC	$73.01	$134.87	$253.04
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $40.59 / $75.04 / $490.69	Facility	26	$40.59	$75.04	$490.69
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $113.40 / $232.97 / $310.33	Professional		$113.40	$232.97	$310.33
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $36.45 / $73.26 / $90.89	Professional	26	$36.45	$73.26	$90.89
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $76.95 / $158.46 / $216.78	Professional	TC	$76.95	$158.46	$216.78
Molina Facility/Professional Professional Modifier Low / Median / High Price $22.36 / $102.17 / $227.89	Professional		$22.36	$102.17	$227.89
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $53.90 / $65.14 / $66.33	Facility	26	$53.90	$65.14	$66.33
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $37.81 / $49.75 / $66.33	Professional	26	$37.81	$49.75	$66.33
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $123.74 / $142.83 / $154.77	Professional	TC	$123.74	$142.83	$154.77
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $44.79 / $44.79 / $44.85	Facility	26	$44.79	$44.79	$44.85
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $172.60 / $258.73 / $310.75	Professional		$172.60	$258.73	$310.75
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $51.10 / $77.06 / $93.30	Professional	26	$51.10	$77.06	$93.30
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $116.82 / $180.33 / $218.09	Professional	TC	$116.82	$180.33	$218.09
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $346.39 / $346.39 / $614.12	Facility	26	$346.39	$346.39	$614.12
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $156.62 / $225.37 / $308.73	Professional		$156.62	$225.37	$308.73
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $45.74 / $67.81 / $91.96	Professional	26	$45.74	$67.81	$91.96
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $110.88 / $159.85 / $216.77	Professional	TC	$110.88	$159.85	$216.77
United Facility/Professional Professional Modifier Low / Median / High Price $105.46 / $127.54 / $306.33	Professional		$105.46	$127.54	$306.33
United Facility/Professional Professional Modifier 26 Low / Median / High Price $35.45 / $41.27 / $97.84	Professional	26	$35.45	$41.27	$97.84
United Facility/Professional Professional Modifier TC Low / Median / High Price $74.65 / $88.34 / $205.28	Professional	TC	$74.65	$88.34	$205.28
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $123.26 / $123.26 / $123.26	Professional		$123.26	$123.26	$123.26
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $34.59 / $34.59 / $34.59	Professional	26	$34.59	$34.59	$34.59
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $88.67 / $88.67 / $88.67	Professional	TC	$88.67	$88.67	$88.67