Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $29.87 / $49.13 / $93.09	Facility	26	$29.87	$49.13	$93.09
Aetna Facility/Professional Professional Modifier Low / Median / High Price $89.65 / $118.98 / $237.96	Professional		$89.65	$118.98	$237.96
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $23.17 / $29.88 / $65.55	Professional	26	$23.17	$29.88	$65.55
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $65.20 / $89.09 / $162.18	Professional	TC	$65.20	$89.09	$162.18
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $185.02 / $185.02 / $185.02	Professional		$185.02	$185.02	$185.02
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $14.54 / $14.54 / $14.54	Professional	26	$14.54	$14.54	$14.54
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $80.00 / $118.08 / $118.08	Facility	26	$80.00	$118.08	$118.08
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $121.61 / $237.48 / $862.65	Professional		$121.61	$237.48	$862.65
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $36.50 / $63.23 / $216.83	Professional	26	$36.50	$63.23	$216.83
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $101.18 / $172.83 / $645.75	Professional	TC	$101.18	$172.83	$645.75
Cigna Facility/Professional Professional Modifier Low / Median / High Price $92.31 / $180.28 / $324.54	Professional		$92.31	$180.28	$324.54
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $26.78 / $46.84 / $79.09	Professional	26	$26.78	$46.84	$79.09
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $67.17 / $129.94 / $245.85	Professional	TC	$67.17	$129.94	$245.85
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $31.57 / $58.92 / $290.81	Facility	26	$31.57	$58.92	$290.81
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $99.51 / $190.55 / $266.05	Professional		$99.51	$190.55	$266.05
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $28.35 / $56.86 / $72.63	Professional	26	$28.35	$56.86	$72.63
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $72.98 / $131.76 / $201.62	Professional	TC	$72.98	$131.76	$201.62
Molina Facility/Professional Professional Modifier Low / Median / High Price $21.52 / $102.70 / $228.88	Professional		$21.52	$102.70	$228.88
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $42.86 / $51.35 / $52.93	Facility	26	$42.86	$51.35	$52.93
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $30.95 / $44.08 / $53.25	Professional	26	$30.95	$44.08	$53.25
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $79.84 / $113.06 / $140.69	Professional	TC	$79.84	$113.06	$140.69
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $35.65 / $35.65 / $35.79	Facility	26	$35.65	$35.65	$35.79
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $154.11 / $228.27 / $280.25	Professional		$154.11	$228.27	$280.25
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $40.78 / $61.34 / $74.26	Professional	26	$40.78	$61.34	$74.26
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $108.71 / $168.47 / $207.14	Professional	TC	$108.71	$168.47	$207.14
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 $137.68 / $204.82 / $268.77	Professional		$137.68	$204.82	$268.77
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $37.92 / $53.98 / $73.20	Professional	26	$37.92	$53.98	$73.20
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $101.18 / $151.38 / $206.23	Professional	TC	$101.18	$151.38	$206.23
United Facility/Professional Professional Modifier Low / Median / High Price $96.72 / $111.83 / $264.85	Professional		$96.72	$111.83	$264.85
United Facility/Professional Professional Modifier 26 Low / Median / High Price $27.41 / $30.18 / $75.05	Professional	26	$27.41	$30.18	$75.05
United Facility/Professional Professional Modifier TC Low / Median / High Price $68.20 / $82.38 / $201.48	Professional	TC	$68.20	$82.38	$201.48
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $113.46 / $113.46 / $113.46	Professional		$113.46	$113.46	$113.46
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $27.28 / $27.28 / $27.28	Professional	26	$27.28	$27.28	$27.28
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $86.19 / $86.19 / $86.19	Professional	TC	$86.19	$86.19	$86.19