Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $42.21 / $80.08 / $152.37	Professional		$42.21	$80.08	$152.37
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.23 / $24.49 / $73.98	Professional	26	$11.23	$24.49	$73.98
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $44.98 / $80.09 / $144.27	Professional	TC	$44.98	$80.09	$144.27
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $5.72 / $9.73 / $22.88	Professional	26	$5.72	$9.73	$22.88
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $35.45 / $35.45 / $35.45	Professional	TC	$35.45	$35.45	$35.45
Asuris Northwest Health Facility/Professional Facility Modifier Low / Median / High Price $115.75 / $372.39 / $372.39	Facility		$115.75	$372.39	$372.39
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 $172.33 / $319.41 / $319.41	Facility	TC	$172.33	$319.41	$319.41
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $99.35 / $193.57 / $721.20	Professional		$99.35	$193.57	$721.20
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $16.17 / $29.05 / $97.05	Professional	26	$16.17	$29.05	$97.05
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $67.86 / $165.80 / $624.15	Professional	TC	$67.86	$165.80	$624.15
Cigna Facility/Professional Professional Modifier Low / Median / High Price $34.15 / $85.78 / $109.41	Professional		$34.15	$85.78	$109.41
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $6.20 / $12.68 / $17.67	Professional	26	$6.20	$12.68	$17.67
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $27.75 / $74.01 / $95.46	Professional	TC	$27.75	$74.01	$95.46
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $62.62 / $132.87 / $219.22	Facility		$62.62	$132.87	$219.22
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $11.53 / $23.71 / $35.89	Facility	26	$11.53	$23.71	$35.89
Kaiser Permanente Facility/Professional Facility Modifier TC Low / Median / High Price $52.70 / $112.46 / $191.01	Facility	TC	$52.70	$112.46	$191.01
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $70.06 / $136.16 / $219.82	Professional		$70.06	$136.16	$219.82
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $14.85 / $26.53 / $33.95	Professional	26	$14.85	$26.53	$33.95
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $58.59 / $112.46 / $191.01	Professional	TC	$58.59	$112.46	$191.01
Molina Facility/Professional Professional Modifier Low / Median / High Price $17.73 / $105.24 / $187.42	Professional		$17.73	$105.24	$187.42
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $104.79 / $143.38 / $166.83	Facility		$104.79	$143.38	$166.83
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $16.96 / $23.12 / $23.45	Facility	26	$16.96	$23.12	$23.45
Pacific Source Facility/Professional Facility Modifier TC Low / Median / High Price $92.34 / $119.93 / $143.38	Facility	TC	$92.34	$119.93	$143.38
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $14.07 / $19.38 / $23.45	Professional	26	$14.07	$19.38	$23.45
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $75.00 / $95.48 / $132.60	Professional	TC	$75.00	$95.48	$132.60
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $112.80 / $186.58 / $224.09	Professional		$112.80	$186.58	$224.09
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $16.22 / $27.47 / $32.14	Professional	26	$16.22	$27.47	$32.14
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $96.94 / $160.35 / $191.95	Professional	TC	$96.94	$160.35	$191.95
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $108.30 / $152.60 / $193.47	Professional		$108.30	$152.60	$193.47
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $16.17 / $22.05 / $28.94	Professional	26	$16.17	$22.05	$28.94
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $88.35 / $131.66 / $165.64	Professional	TC	$88.35	$131.66	$165.64
United Facility/Professional Professional Modifier Low / Median / High Price $46.34 / $65.65 / $120.22	Professional		$46.34	$65.65	$120.22
United Facility/Professional Professional Modifier 26 Low / Median / High Price $7.52 / $7.96 / $25.28	Professional	26	$7.52	$7.96	$25.28
United Facility/Professional Professional Modifier TC Low / Median / High Price $38.76 / $42.49 / $100.56	Professional	TC	$38.76	$42.49	$100.56