Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $27.44 / $35.68 / $105.38	Professional		$27.44	$35.68	$105.38
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.55 / $13.28 / $45.41	Professional	26	$8.55	$13.28	$45.41
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $21.56 / $34.33 / $48.29	Professional	TC	$21.56	$34.33	$48.29
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $25.76 / $25.76 / $85.34	Professional		$25.76	$25.76	$85.34
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $5.39 / $9.90 / $21.58	Professional	26	$5.39	$9.90	$21.58
Asuris Northwest Health Facility/Professional Facility Modifier Low / Median / High Price $105.38 / $208.80 / $208.80	Facility		$105.38	$208.80	$208.80
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 Facility Modifier TC Low / Median / High Price $100.00 / $164.16 / $164.16	Facility	TC	$100.00	$164.16	$164.16
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $55.05 / $102.90 / $372.45	Professional		$55.05	$102.90	$372.45
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $15.25 / $25.94 / $191.54	Professional	26	$15.25	$25.94	$191.54
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $36.60 / $77.52 / $280.64	Professional	TC	$36.60	$77.52	$280.64
Cigna Facility/Professional Professional Modifier Low / Median / High Price $21.01 / $44.26 / $64.39	Professional		$21.01	$44.26	$64.39
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $5.86 / $11.98 / $17.20	Professional	26	$5.86	$11.98	$17.20
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $14.90 / $33.15 / $51.62	Professional	TC	$14.90	$33.15	$51.62
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $40.92 / $87.12 / $139.68	Facility		$40.92	$87.12	$139.68
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $10.87 / $22.35 / $33.75	Facility	26	$10.87	$22.35	$33.75
Kaiser Permanente Facility/Professional Facility Modifier TC Low / Median / High Price $30.69 / $68.68 / $105.93	Facility	TC	$30.69	$68.68	$105.93
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $42.82 / $89.43 / $116.57	Professional		$42.82	$89.43	$116.57
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $11.16 / $22.35 / $30.87	Professional	26	$11.16	$22.35	$30.87
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $31.94 / $68.68 / $88.48	Professional	TC	$31.94	$68.68	$88.48
Molina Facility/Professional Professional Modifier Low / Median / High Price $8.86 / $52.62 / $93.71	Professional		$8.86	$52.62	$93.71
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $66.12 / $82.96 / $91.32	Facility		$66.12	$82.96	$91.32
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $16.47 / $21.78 / $22.78	Facility	26	$16.47	$21.78	$22.78
Pacific Source Facility/Professional Facility Modifier TC Low / Median / High Price $46.74 / $59.63 / $64.31	Facility	TC	$46.74	$59.63	$64.31
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $14.40 / $18.55 / $26.73	Professional	26	$14.40	$18.55	$26.73
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $37.39 / $64.19 / $83.66	Professional	TC	$37.39	$64.19	$83.66
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $58.85 / $96.66 / $116.64	Professional		$58.85	$96.66	$116.64
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $15.29 / $25.90 / $30.31	Professional	26	$15.29	$25.90	$30.31
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $43.56 / $71.65 / $86.33	Professional	TC	$43.56	$71.65	$86.33
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $56.36 / $80.01 / $102.90	Professional		$56.36	$80.01	$102.90
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $15.25 / $20.79 / $27.28	Professional	26	$15.25	$20.79	$27.28
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $41.12 / $59.22 / $77.52	Professional	TC	$41.12	$59.22	$77.52
United Facility/Professional Professional Modifier Low / Median / High Price $25.12 / $41.40 / $91.74	Professional		$25.12	$41.40	$91.74
United Facility/Professional Professional Modifier 26 Low / Median / High Price $7.09 / $7.28 / $23.83	Professional	26	$7.09	$7.28	$23.83
United Facility/Professional Professional Modifier TC Low / Median / High Price $17.97 / $29.95 / $61.10	Professional	TC	$17.97	$29.95	$61.10