Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $32.15 / $55.03 / $70.70	Facility	26	$32.15	$55.03	$70.70
Aetna Facility/Professional Professional Modifier Low / Median / High Price $95.27 / $146.12 / $329.89	Professional		$95.27	$146.12	$329.89
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $26.72 / $32.61 / $58.55	Professional	26	$26.72	$32.61	$58.55
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $65.98 / $103.18 / $272.06	Professional	TC	$65.98	$103.18	$272.06
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $19.75 / $19.75 / $19.75	Professional	26	$19.75	$19.75	$19.75
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $82.93 / $160.47 / $160.47	Facility	26	$82.93	$160.47	$160.47
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $222.68 / $401.26 / $1,341.64	Professional		$222.68	$401.26	$1,341.64
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $35.52 / $64.18 / $375.24	Professional	26	$35.52	$64.18	$375.24
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $177.87 / $334.89 / $1,090.58	Professional	TC	$177.87	$334.89	$1,090.58
Cigna Facility/Professional Professional Modifier Low / Median / High Price $192.46 / $331.18 / $527.13	Professional		$192.46	$331.18	$527.13
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $31.00 / $49.54 / $80.40	Professional	26	$31.00	$49.54	$80.40
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $157.29 / $282.66 / $454.44	Professional	TC	$157.29	$282.66	$454.44
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $28.21 / $54.94 / $89.01	Facility	26	$28.21	$54.94	$89.01
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $189.28 / $341.32 / $495.63	Professional		$189.28	$341.32	$495.63
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $28.21 / $53.65 / $74.06	Professional	26	$28.21	$53.65	$74.06
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $157.87 / $284.69 / $424.53	Professional	TC	$157.87	$284.69	$424.53
Molina Facility/Professional Professional Modifier Low / Median / High Price $29.15 / $151.38 / $373.59	Professional		$29.15	$151.38	$373.59
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $40.15 / $48.91 / $58.30	Facility	26	$40.15	$48.91	$58.30
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $33.86 / $47.36 / $59.15	Professional	26	$33.86	$47.36	$59.15
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $164.02 / $235.17 / $328.86	Professional	TC	$164.02	$235.17	$328.86
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $33.36 / $33.36 / $33.52	Facility	26	$33.36	$33.36	$33.52
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $245.89 / $365.14 / $448.97	Professional		$245.89	$365.14	$448.97
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $38.15 / $56.50 / $68.42	Professional	26	$38.15	$56.50	$68.42
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $207.75 / $309.49 / $380.54	Professional	TC	$207.75	$309.49	$380.54
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 $222.68 / $314.89 / $424.15	Professional		$222.68	$314.89	$424.15
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $34.19 / $48.10 / $64.64	Professional	26	$34.19	$48.10	$64.64
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $188.50 / $266.89 / $359.51	Professional	TC	$188.50	$266.89	$359.51
United Facility/Professional Professional Modifier Low / Median / High Price $189.00 / $293.07 / $460.54	Professional		$189.00	$293.07	$460.54
United Facility/Professional Professional Modifier 26 Low / Median / High Price $29.96 / $46.98 / $73.13	Professional	26	$29.96	$46.98	$73.13
United Facility/Professional Professional Modifier TC Low / Median / High Price $153.60 / $241.91 / $385.71	Professional	TC	$153.60	$241.91	$385.71
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $166.77 / $166.77 / $166.77	Professional		$166.77	$166.77	$166.77
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $37.18 / $37.18 / $37.18	Professional	26	$37.18	$37.18	$37.18
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $129.59 / $129.59 / $129.59	Professional	TC	$129.59	$129.59	$129.59