Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $45.66 / $69.11 / $149.60	Professional		$45.66	$69.11	$149.60
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $17.47 / $27.31 / $69.83	Professional	26	$17.47	$27.31	$69.83
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $46.07 / $49.64 / $126.65	Professional	TC	$46.07	$49.64	$126.65
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $10.66 / $36.24 / $58.68	Professional	26	$10.66	$36.24	$58.68
Asuris Northwest Health Facility/Professional Facility Modifier Low / Median / High Price $171.77 / $317.91 / $317.91	Facility		$171.77	$317.91	$317.91
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $100.00 / $113.52 / $113.52	Facility	26	$100.00	$113.52	$113.52
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $85.80 / $159.44 / $591.00	Professional		$85.80	$159.44	$591.00
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $29.45 / $51.05 / $244.00	Professional	26	$29.45	$51.05	$244.00
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $53.58 / $105.65 / $411.68	Professional	TC	$53.58	$105.65	$411.68
Cigna Facility/Professional Professional Modifier Low / Median / High Price $31.96 / $70.67 / $102.48	Professional		$31.96	$70.67	$102.48
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.84 / $23.95 / $32.86	Professional	26	$11.84	$23.95	$32.86
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $19.45 / $48.73 / $70.66	Professional	TC	$19.45	$48.73	$70.66
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $59.83 / $124.80 / $205.40	Facility		$59.83	$124.80	$205.40
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $21.70 / $43.68 / $66.56	Facility	26	$21.70	$43.68	$66.56
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $73.84 / $143.97 / $197.22	Professional		$73.84	$143.97	$197.22
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $28.01 / $44.03 / $60.88	Professional	26	$28.01	$44.03	$60.88
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $52.39 / $91.68 / $136.34	Professional	TC	$52.39	$91.68	$136.34
Molina Facility/Professional Professional Modifier Low / Median / High Price $13.58 / $69.50 / $159.55	Professional		$13.58	$69.50	$159.55
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $99.96 / $124.44 / $139.87	Facility		$99.96	$124.44	$139.87
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $35.74 / $43.12 / $49.78	Facility	26	$35.74	$43.12	$49.78
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $26.40 / $38.76 / $47.52	Professional	26	$26.40	$38.76	$47.52
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $44.55 / $73.20 / $94.47	Professional	TC	$44.55	$73.20	$94.47
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $93.32 / $152.15 / $180.92	Professional		$93.32	$152.15	$180.92
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $30.18 / $51.02 / $59.70	Professional	26	$30.18	$51.02	$59.70
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $63.87 / $99.82 / $121.23	Professional	TC	$63.87	$99.82	$121.23
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $87.32 / $124.11 / $159.44	Professional		$87.32	$124.11	$159.44
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $30.03 / $42.28 / $53.74	Professional	26	$30.03	$42.28	$53.74
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $57.29 / $83.16 / $109.13	Professional	TC	$57.29	$83.16	$109.13
United Facility/Professional Professional Modifier Low / Median / High Price $37.90 / $43.82 / $128.86	Professional		$37.90	$43.82	$128.86
United Facility/Professional Professional Modifier 26 Low / Median / High Price $14.08 / $18.64 / $36.52	Professional	26	$14.08	$18.64	$36.52
United Facility/Professional Professional Modifier TC Low / Median / High Price $23.82 / $29.64 / $61.80	Professional	TC	$23.82	$29.64	$61.80