Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $20.22 / $32.72 / $64.81	Facility	26	$20.22	$32.72	$64.81
Aetna Facility/Professional Professional Modifier Low / Median / High Price $94.03 / $125.55 / $228.81	Professional		$94.03	$125.55	$228.81
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $16.60 / $20.44 / $53.10	Professional	26	$16.60	$20.44	$53.10
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $73.59 / $104.82 / $182.71	Professional	TC	$73.59	$104.82	$182.71
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $181.58 / $181.58 / $181.58	Professional		$181.58	$181.58	$181.58
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $18.66 / $30.79 / $47.96	Professional	26	$18.66	$30.79	$47.96
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $24.46 / $81.76 / $81.76	Facility	26	$24.46	$81.76	$81.76
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $130.30 / $239.58 / $858.23	Professional		$130.30	$239.58	$858.23
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $24.95 / $43.22 / $149.63	Professional	26	$24.95	$43.22	$149.63
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $111.05 / $196.34 / $708.60	Professional	TC	$111.05	$196.34	$708.60
Cigna Facility/Professional Professional Modifier Low / Median / High Price $99.73 / $181.84 / $322.36	Professional		$99.73	$181.84	$322.36
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $19.66 / $32.86 / $53.25	Professional	26	$19.66	$32.86	$53.25
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $77.79 / $151.43 / $269.00	Professional	TC	$77.79	$151.43	$269.00
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $17.36 / $37.32 / $48.91	Facility	26	$17.36	$37.32	$48.91
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $101.85 / $183.67 / $281.51	Professional		$101.85	$183.67	$281.51
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $17.52 / $38.42 / $48.02	Professional	26	$17.52	$38.42	$48.02
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $79.36 / $146.88 / $232.59	Professional	TC	$79.36	$146.88	$232.59
Molina Facility/Professional Professional Modifier Low / Median / High Price $17.99 / $109.26 / $183.43	Professional		$17.99	$109.26	$183.43
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $29.15 / $35.11 / $36.18	Facility	26	$29.15	$35.11	$36.18
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $22.68 / $32.61 / $38.07	Professional	26	$22.68	$32.61	$38.07
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $84.92 / $123.28 / $180.65	Professional	TC	$84.92	$123.28	$180.65
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $24.22 / $24.22 / $24.46	Facility	26	$24.22	$24.22	$24.46
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $148.55 / $229.79 / $277.44	Professional		$148.55	$229.79	$277.44
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $26.80 / $41.02 / $49.68	Professional	26	$26.80	$41.02	$49.68
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $121.92 / $189.46 / $227.76	Professional	TC	$121.92	$189.46	$227.76
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $142.30 / $202.76 / $275.41	Professional		$142.30	$202.76	$275.41
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $24.95 / $36.54 / $48.74	Professional	26	$24.95	$36.54	$48.74
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $117.35 / $166.46 / $227.13	Professional	TC	$117.35	$166.46	$227.13
United Facility/Professional Professional Modifier Low / Median / High Price $97.80 / $112.57 / $275.33	Professional		$97.80	$112.57	$275.33
United Facility/Professional Professional Modifier 26 Low / Median / High Price $19.11 / $21.04 / $50.00	Professional	26	$19.11	$21.04	$50.00
United Facility/Professional Professional Modifier TC Low / Median / High Price $78.67 / $92.81 / $252.61	Professional	TC	$78.67	$92.81	$252.61
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $112.07 / $112.07 / $112.07	Professional		$112.07	$112.07	$112.07
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $18.66 / $18.66 / $18.66	Professional	26	$18.66	$18.66	$18.66
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $93.41 / $93.41 / $93.41	Professional	TC	$93.41	$93.41	$93.41