Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $25.45 / $35.08 / $94.55	Professional		$25.45	$35.08	$94.55
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $6.45 / $10.39 / $31.84	Professional	26	$6.45	$10.39	$31.84
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $20.23 / $28.06 / $96.58	Professional	TC	$20.23	$28.06	$96.58
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $16.68 / $19.97 / $66.70	Professional		$16.68	$19.97	$66.70
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $3.26 / $11.07 / $17.89	Professional	26	$3.26	$11.07	$17.89
Asuris Northwest Health Facility/Professional Facility Modifier Low / Median / High Price $82.73 / $162.36 / $162.36	Facility		$82.73	$162.36	$162.36
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $100.00 / $100.00 / $100.00	Facility	26	$100.00	$100.00	$100.00
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $39.99 / $80.23 / $290.25	Professional		$39.99	$80.23	$290.25
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $9.24 / $15.71 / $145.30	Professional	26	$9.24	$15.71	$145.30
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $31.92 / $63.76 / $234.08	Professional	TC	$31.92	$63.76	$234.08
Cigna Facility/Professional Professional Modifier Low / Median / High Price $15.94 / $34.32 / $49.76	Professional		$15.94	$34.32	$49.76
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $3.61 / $7.23 / $10.68	Professional	26	$3.61	$7.23	$10.68
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $12.17 / $27.62 / $40.04	Professional	TC	$12.17	$27.62	$40.04
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $28.52 / $68.64 / $107.81	Facility		$28.52	$68.64	$107.81
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $6.82 / $13.55 / $20.62	Facility	26	$6.82	$13.55	$20.62
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $37.77 / $72.68 / $88.77	Professional		$37.77	$72.68	$88.77
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $8.91 / $13.81 / $18.86	Professional	26	$8.91	$13.81	$18.86
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $28.85 / $56.88 / $71.25	Professional	TC	$28.85	$56.88	$71.25
Molina Facility/Professional Professional Modifier Low / Median / High Price $8.85 / $52.59 / $93.58	Professional		$8.85	$52.59	$93.58
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $49.59 / $62.56 / $72.00	Facility		$49.59	$62.56	$72.00
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $10.83 / $13.10 / $14.07	Facility	26	$10.83	$13.10	$14.07
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $8.03 / $11.40 / $14.07	Professional	26	$8.03	$11.40	$14.07
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $30.03 / $42.24 / $70.02	Professional	TC	$30.03	$42.24	$70.02
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $45.41 / $74.87 / $90.00	Professional		$45.41	$74.87	$90.00
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $9.34 / $15.70 / $18.37	Professional	26	$9.34	$15.70	$18.37
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $36.24 / $58.77 / $71.64	Professional	TC	$36.24	$58.77	$71.64
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $42.97 / $61.41 / $81.04	Professional		$42.97	$61.41	$81.04
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $9.24 / $12.60 / $16.54	Professional	26	$9.24	$12.60	$16.54
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $33.72 / $49.14 / $63.42	Professional	TC	$33.72	$49.14	$63.42
United Facility/Professional Professional Modifier Low / Median / High Price $18.84 / $31.40 / $49.04	Professional		$18.84	$31.40	$49.04
United Facility/Professional Professional Modifier 26 Low / Median / High Price $4.07 / $4.55 / $14.45	Professional	26	$4.07	$4.55	$14.45
United Facility/Professional Professional Modifier TC Low / Median / High Price $14.51 / $22.51 / $42.40	Professional	TC	$14.51	$22.51	$42.40