Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $20.05 / $20.05 / $20.29	Facility	26	$20.05	$20.05	$20.29
Aetna Facility/Professional Professional Modifier Low / Median / High Price $68.06 / $80.67 / $182.26	Professional		$68.06	$80.67	$182.26
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $17.82 / $21.37 / $44.84	Professional	26	$17.82	$21.37	$44.84
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $50.22 / $60.61 / $101.43	Professional	TC	$50.22	$60.61	$101.43
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $74.05 / $75.72 / $83.29	Professional		$74.05	$75.72	$83.29
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $20.29 / $25.30 / $44.00	Professional	26	$20.29	$25.30	$44.00
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $26.73 / $104.06 / $104.06	Facility	26	$26.73	$104.06	$104.06
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $100.25 / $169.68 / $651.75	Professional		$100.25	$169.68	$651.75
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $27.26 / $46.34 / $170.18	Professional	26	$27.26	$46.34	$170.18
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $73.00 / $123.27 / $481.50	Professional	TC	$73.00	$123.27	$481.50
Cigna Facility/Professional Professional Modifier Low / Median / High Price $67.55 / $67.55 / $67.55	Professional		$67.55	$67.55	$67.55
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $18.45 / $18.45 / $18.45	Professional	26	$18.45	$18.45	$18.45
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $49.10 / $49.10 / $49.10	Professional	TC	$49.10	$49.10	$49.10
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $18.91 / $38.15 / $54.69	Facility	26	$18.91	$38.15	$54.69
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $75.95 / $168.36 / $219.69	Professional		$75.95	$168.36	$219.69
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $19.07 / $44.38 / $54.69	Professional	26	$19.07	$44.38	$54.69
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $56.73 / $123.97 / $164.09	Professional	TC	$56.73	$123.97	$164.09
Molina Facility/Professional Professional Modifier Low / Median / High Price $17.90 / $105.73 / $179.97	Professional		$17.90	$105.73	$179.97
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $28.10 / $38.86 / $40.86	Facility	26	$28.10	$38.86	$40.86
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $26.84 / $36.92 / $42.63	Professional	26	$26.84	$36.92	$42.63
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $75.84 / $105.19 / $115.40	Professional	TC	$75.84	$105.19	$115.40
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $26.73 / $26.73 / $27.88	Facility	26	$26.73	$26.73	$27.88
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $114.56 / $172.28 / $206.86	Professional		$114.56	$172.28	$206.86
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $31.34 / $46.50 / $55.55	Professional	26	$31.34	$46.50	$55.55
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $83.44 / $123.27 / $151.63	Professional	TC	$83.44	$123.27	$151.63
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $100.25 / $147.01 / $200.12	Professional		$100.25	$147.01	$200.12
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $27.26 / $39.68 / $53.34	Professional	26	$27.26	$39.68	$53.34
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $73.00 / $107.33 / $146.11	Professional	TC	$73.00	$107.33	$146.11
United Facility/Professional Professional Modifier Low / Median / High Price $91.81 / $103.88 / $203.31	Professional		$91.81	$103.88	$203.31
United Facility/Professional Professional Modifier 26 Low / Median / High Price $23.21 / $26.16 / $52.84	Professional	26	$23.21	$26.16	$52.84
United Facility/Professional Professional Modifier TC Low / Median / High Price $67.29 / $85.10 / $152.19	Professional	TC	$67.29	$85.10	$152.19