Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $23.58 / $46.15 / $78.44	Facility	26	$23.58	$46.15	$78.44
Aetna Facility/Professional Professional Modifier Low / Median / High Price $55.52 / $77.81 / $168.21	Professional		$55.52	$77.81	$168.21
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $18.11 / $23.58 / $57.87	Professional	26	$18.11	$23.58	$57.87
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $37.40 / $54.25 / $111.79	Professional	TC	$37.40	$54.25	$111.79
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $34.74 / $34.74 / $34.74	Professional	26	$34.74	$34.74	$34.74
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $80.00 / $94.47 / $94.47	Facility	26	$80.00	$94.47	$94.47
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $90.09 / $154.69 / $563.10	Professional		$90.09	$154.69	$563.10
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $28.64 / $51.26 / $171.83	Professional	26	$28.64	$51.26	$171.83
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $61.45 / $105.51 / $391.28	Professional	TC	$61.45	$105.51	$391.28
Cigna Facility/Professional Professional Modifier Low / Median / High Price $65.65 / $120.08 / $211.54	Professional		$65.65	$120.08	$211.54
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $22.59 / $39.04 / $62.95	Professional	26	$22.59	$39.04	$62.95
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $43.44 / $82.52 / $149.13	Professional	TC	$43.44	$82.52	$149.13
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $21.08 / $47.12 / $290.81	Facility	26	$21.08	$47.12	$290.81
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $65.41 / $138.83 / $181.13	Professional		$65.41	$138.83	$181.13
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $21.08 / $45.77 / $57.45	Professional	26	$21.08	$45.77	$57.45
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $45.88 / $90.30 / $121.31	Professional	TC	$45.88	$90.30	$121.31
Molina Facility/Professional Professional Modifier Low / Median / High Price $9.20 / $54.50 / $92.81	Professional		$9.20	$54.50	$92.81
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $34.08 / $40.90 / $43.55	Facility	26	$34.08	$40.90	$43.55
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $26.13 / $33.50 / $43.55	Professional	26	$26.13	$33.50	$43.55
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $51.21 / $70.00 / $90.01	Professional	TC	$51.21	$70.00	$90.01
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $28.09 / $28.09 / $28.33	Facility	26	$28.09	$28.09	$28.33
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $100.17 / $149.41 / $183.71	Professional		$100.17	$149.41	$183.71
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $31.96 / $48.15 / $59.01	Professional	26	$31.96	$48.15	$59.01
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $68.56 / $102.15 / $125.60	Professional	TC	$68.56	$102.15	$125.60
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 $90.09 / $134.26 / $176.05	Professional		$90.09	$134.26	$176.05
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $29.76 / $42.90 / $59.78	Professional	26	$29.76	$42.90	$59.78
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $61.45 / $91.79 / $124.21	Professional	TC	$61.45	$91.79	$124.21
United Facility/Professional Professional Modifier Low / Median / High Price $64.23 / $72.69 / $185.25	Professional		$64.23	$72.69	$185.25
United Facility/Professional Professional Modifier 26 Low / Median / High Price $22.74 / $24.89 / $58.90	Professional	26	$22.74	$24.89	$58.90
United Facility/Professional Professional Modifier TC Low / Median / High Price $41.50 / $50.01 / $115.20	Professional	TC	$41.50	$50.01	$115.20
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $74.47 / $74.47 / $74.47	Professional		$74.47	$74.47	$74.47
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $21.71 / $21.71 / $21.71	Professional	26	$21.71	$21.71	$21.71
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $52.76 / $52.76 / $52.76	Professional	TC	$52.76	$52.76	$52.76