Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $16.44 / $29.00 / $53.19	Facility	26	$16.44	$29.00	$53.19
Aetna Facility/Professional Professional Modifier Low / Median / High Price $46.52 / $63.03 / $146.77	Professional		$46.52	$63.03	$146.77
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.57 / $16.44 / $34.44	Professional	26	$12.57	$16.44	$34.44
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $33.04 / $46.51 / $95.64	Professional	TC	$33.04	$46.51	$95.64
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $38.49 / $38.49 / $123.72	Professional		$38.49	$38.49	$123.72
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 $69.76 / $122.22 / $461.85	Professional		$69.76	$122.22	$461.85
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $19.87 / $34.11 / $115.95	Professional	26	$19.87	$34.11	$115.95
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $50.38 / $88.66 / $345.98	Professional	TC	$50.38	$88.66	$345.98
Cigna Facility/Professional Professional Modifier Low / Median / High Price $56.52 / $99.05 / $172.62	Professional		$56.52	$99.05	$172.62
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $15.27 / $26.30 / $42.72	Professional	26	$15.27	$26.30	$42.72
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $41.58 / $73.12 / $130.96	Professional	TC	$41.58	$73.12	$130.96
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $17.63 / $32.59 / $290.81	Facility	26	$17.63	$32.59	$290.81
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $55.80 / $114.08 / $152.29	Professional		$55.80	$114.08	$152.29
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $15.83 / $31.76 / $39.44	Professional	26	$15.83	$31.76	$39.44
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $41.85 / $83.79 / $112.60	Professional	TC	$41.85	$83.79	$112.60
Molina Facility/Professional Professional Modifier Low / Median / High Price $9.15 / $54.73 / $92.91	Professional		$9.15	$54.73	$92.91
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $23.09 / $27.80 / $29.48	Facility	26	$23.09	$27.80	$29.48
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $18.47 / $24.27 / $30.21	Professional	26	$18.47	$24.27	$30.21
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $54.27 / $69.54 / $79.06	Professional	TC	$54.27	$69.54	$79.06
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $19.19 / $19.19 / $19.48	Facility	26	$19.19	$19.19	$19.48
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $80.91 / $121.97 / $149.97	Professional		$80.91	$121.97	$149.97
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $22.20 / $32.72 / $39.97	Professional	26	$22.20	$32.72	$39.97
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $57.74 / $86.58 / $110.60	Professional	TC	$57.74	$86.58	$110.60
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 $69.76 / $107.51 / $148.07	Professional		$69.76	$107.51	$148.07
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $20.64 / $29.06 / $39.54	Professional	26	$20.64	$29.06	$39.54
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $53.03 / $77.58 / $108.52	Professional	TC	$53.03	$77.58	$108.52
United Facility/Professional Professional Modifier Low / Median / High Price $39.51 / $55.50 / $147.26	Professional		$39.51	$55.50	$147.26
United Facility/Professional Professional Modifier 26 Low / Median / High Price $11.07 / $16.78 / $40.85	Professional	26	$11.07	$16.78	$40.85
United Facility/Professional Professional Modifier TC Low / Median / High Price $28.44 / $40.00 / $106.36	Professional	TC	$28.44	$40.00	$106.36
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $61.86 / $61.86 / $61.86	Professional		$61.86	$61.86	$61.86
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $14.74 / $14.74 / $14.74	Professional	26	$14.74	$14.74	$14.74
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $47.12 / $47.12 / $47.12	Professional	TC	$47.12	$47.12	$47.12