Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $23.62 / $25.75 / $59.13	Facility	26	$23.62	$25.75	$59.13
Aetna Facility/Professional Professional Modifier Low / Median / High Price $46.14 / $55.16 / $175.00	Professional		$46.14	$55.16	$175.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $23.63 / $28.99 / $54.11	Professional	26	$23.63	$28.99	$54.11
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $54.11 / $54.11 / $54.11	Professional	52	$54.11	$54.11	$54.11
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $19.88 / $24.46 / $52.61	Professional	TC	$19.88	$24.46	$52.61
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $34.72 / $81.40 / $87.06	Professional		$34.72	$81.40	$87.06
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $30.63 / $45.74 / $55.04	Professional	26	$30.63	$45.74	$55.04
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $49.41 / $141.63 / $141.63	Facility	26	$49.41	$141.63	$141.63
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $70.65 / $115.44 / $401.93	Professional		$70.65	$115.44	$401.93
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $39.72 / $66.27 / $233.10	Professional	26	$39.72	$66.27	$233.10
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $29.71 / $51.36 / $168.83	Professional	TC	$29.71	$51.36	$168.83
Cigna Facility/Professional Professional Modifier Low / Median / High Price $39.28 / $39.28 / $39.28	Professional		$39.28	$39.28	$39.28
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $25.29 / $25.29 / $25.29	Professional	26	$25.29	$25.29	$25.29
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $13.99 / $13.99 / $13.99	Professional	TC	$13.99	$13.99	$13.99
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $31.29 / $65.05 / $86.34	Facility	26	$31.29	$65.05	$86.34
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $57.80 / $119.03 / $153.33	Professional		$57.80	$119.03	$153.33
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $27.90 / $59.85 / $78.45	Professional	26	$27.90	$59.85	$78.45
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $25.34 / $52.20 / $70.03	Professional	TC	$25.34	$52.20	$70.03
Molina Facility/Professional Professional Modifier Low / Median / High Price $16.37 / $81.09 / $166.40	Professional		$16.37	$81.09	$166.40
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $46.20 / $56.03 / $57.62	Facility	26	$46.20	$56.03	$57.62
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $34.31 / $46.20 / $59.34	Professional	26	$34.31	$46.20	$59.34
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $25.85 / $31.90 / $50.58	Professional	TC	$25.85	$31.90	$50.58
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $38.39 / $38.39 / $38.96	Facility	26	$38.39	$38.39	$38.96
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $76.62 / $113.55 / $140.81	Professional		$76.62	$113.55	$140.81
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $44.17 / $65.44 / $79.97	Professional	26	$44.17	$65.44	$79.97
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $31.71 / $51.75 / $64.48	Professional	TC	$31.71	$51.75	$64.48
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $49.41 / $49.41 / $64.77	Facility	26	$49.41	$49.41	$64.77
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $72.06 / $100.46 / $131.46	Professional		$72.06	$100.46	$131.46
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $39.72 / $55.90 / $75.45	Professional	26	$39.72	$55.90	$75.45
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $32.34 / $44.60 / $59.76	Professional	TC	$32.34	$44.60	$59.76
United Facility/Professional Professional Modifier Low / Median / High Price $58.89 / $69.37 / $153.18	Professional		$58.89	$69.37	$153.18
United Facility/Professional Professional Modifier 26 Low / Median / High Price $32.19 / $39.11 / $81.70	Professional	26	$32.19	$39.11	$81.70
United Facility/Professional Professional Modifier TC Low / Median / High Price $26.95 / $31.16 / $69.17	Professional	TC	$26.95	$31.16	$69.17