Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $9.89 / $16.14 / $31.49	Facility	26	$9.89	$16.14	$31.49
Aetna Facility/Professional Professional Modifier Low / Median / High Price $29.87 / $40.65 / $89.57	Professional		$29.87	$40.65	$89.57
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.59 / $9.83 / $19.78	Professional	26	$7.59	$9.83	$19.78
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $21.94 / $31.77 / $64.77	Professional	TC	$21.94	$31.77	$64.77
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $13.99 / $13.99 / $13.99	Professional	26	$13.99	$13.99	$13.99
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 Professional Modifier Low / Median / High Price $51.74 / $92.60 / $338.48	Professional		$51.74	$92.60	$338.48
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $12.01 / $21.12 / $72.38	Professional	26	$12.01	$21.12	$72.38
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $39.49 / $70.43 / $283.00	Professional	TC	$39.49	$70.43	$283.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $34.29 / $63.22 / $126.93	Professional		$34.29	$63.22	$126.93
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $9.03 / $15.75 / $26.37	Professional	26	$9.03	$15.75	$26.37
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $24.31 / $47.58 / $99.53	Professional	TC	$24.31	$47.58	$99.53
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $10.19 / $19.70 / $236.39	Facility	26	$10.19	$19.70	$236.39
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $32.86 / $65.84 / $103.08	Professional		$32.86	$65.84	$103.08
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $9.38 / $18.95 / $24.01	Professional	26	$9.38	$18.95	$24.01
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $24.80 / $47.43 / $80.59	Professional	TC	$24.80	$47.43	$80.59
Molina Facility/Professional Professional Modifier Low / Median / High Price $9.15 / $54.50 / $92.81	Professional		$9.15	$54.50	$92.81
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $13.23 / $17.12 / $17.42	Facility	26	$13.23	$17.12	$17.42
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $11.44 / $15.68 / $19.82	Professional	26	$11.44	$15.68	$19.82
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $29.35 / $43.85 / $60.97	Professional	TC	$29.35	$43.85	$60.97
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $11.78 / $11.78 / $11.88	Facility	26	$11.78	$11.78	$11.88
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $59.17 / $89.19 / $109.66	Professional		$59.17	$89.19	$109.66
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $13.40 / $20.12 / $24.37	Professional	26	$13.40	$20.12	$24.37
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $44.27 / $69.37 / $85.29	Professional	TC	$44.27	$69.37	$85.29
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $156.94 / $156.94 / $209.36	Facility	26	$156.94	$156.94	$209.36
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $53.13 / $80.15 / $105.09	Professional		$53.13	$80.15	$105.09
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $12.48 / $17.88 / $24.28	Professional	26	$12.48	$17.88	$24.28
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $41.12 / $61.62 / $83.81	Professional	TC	$41.12	$61.62	$83.81
United Facility/Professional Professional Modifier Low / Median / High Price $31.98 / $42.98 / $101.79	Professional		$31.98	$42.98	$101.79
United Facility/Professional Professional Modifier 26 Low / Median / High Price $9.02 / $10.27 / $24.70	Professional	26	$9.02	$10.27	$24.70
United Facility/Professional Professional Modifier TC Low / Median / High Price $23.75 / $33.54 / $77.95	Professional	TC	$23.75	$33.54	$77.95
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $44.51 / $44.51 / $44.51	Professional		$44.51	$44.51	$44.51
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $9.11 / $9.11 / $9.11	Professional	26	$9.11	$9.11	$9.11
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $35.40 / $35.40 / $35.40	Professional	TC	$35.40	$35.40	$35.40