Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $14.10 / $16.36 / $40.89	Facility	26	$14.10	$16.36	$40.89
Aetna Facility/Professional Professional Modifier Low / Median / High Price $38.77 / $56.88 / $119.81	Professional		$38.77	$56.88	$119.81
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.81 / $14.11 / $31.03	Professional	26	$10.81	$14.11	$31.03
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $27.55 / $42.77 / $74.98	Professional	TC	$27.55	$42.77	$74.98
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $36.57 / $87.27 / $87.27	Professional		$36.57	$87.27	$87.27
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $17.53 / $18.14 / $21.43	Professional	26	$17.53	$18.14	$21.43
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 $65.20 / $113.57 / $409.28	Professional		$65.20	$113.57	$409.28
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $17.09 / $29.95 / $102.38	Professional	26	$17.09	$29.95	$102.38
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $48.51 / $81.27 / $306.89	Professional	TC	$48.51	$81.27	$306.89
Cigna Facility/Professional Professional Modifier Low / Median / High Price $42.54 / $79.09 / $153.52	Professional		$42.54	$79.09	$153.52
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $13.24 / $22.81 / $37.61	Professional	26	$13.24	$22.81	$37.61
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $30.66 / $55.66 / $115.13	Professional	TC	$30.66	$55.66	$115.13
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $12.40 / $27.98 / $290.81	Facility	26	$12.40	$27.98	$290.81
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $40.98 / $85.67 / $125.07	Professional		$40.98	$85.67	$125.07
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $12.40 / $26.71 / $34.15	Professional	26	$12.40	$26.71	$34.15
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $28.83 / $59.42 / $93.70	Professional	TC	$28.83	$59.42	$93.70
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 $20.14 / $24.46 / $25.46	Facility	26	$20.14	$24.46	$25.46
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $15.16 / $21.66 / $26.30	Professional	26	$15.16	$21.66	$26.30
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $33.18 / $48.45 / $68.00	Professional	TC	$33.18	$48.45	$68.00
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $16.76 / $16.76 / $16.91	Facility	26	$16.76	$16.76	$16.91
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $72.43 / $108.32 / $133.10	Professional		$72.43	$108.32	$133.10
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $19.07 / $28.64 / $34.68	Professional	26	$19.07	$28.64	$34.68
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $51.69 / $80.04 / $98.42	Professional	TC	$51.69	$80.04	$98.42
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 $65.59 / $97.27 / $128.08	Professional		$65.59	$97.27	$128.08
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $17.76 / $25.56 / $34.95	Professional	26	$17.76	$25.56	$34.95
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $48.51 / $71.93 / $97.13	Professional	TC	$48.51	$71.93	$97.13
United Facility/Professional Professional Modifier Low / Median / High Price $43.57 / $53.83 / $133.94	Professional		$43.57	$53.83	$133.94
United Facility/Professional Professional Modifier 26 Low / Median / High Price $13.01 / $15.08 / $37.54	Professional	26	$13.01	$15.08	$37.54
United Facility/Professional Professional Modifier TC Low / Median / High Price $29.80 / $38.76 / $94.81	Professional	TC	$29.80	$38.76	$94.81
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $53.52 / $53.52 / $53.52	Professional		$53.52	$53.52	$53.52
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $12.99 / $12.99 / $12.99	Professional	26	$12.99	$12.99	$12.99
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $40.53 / $40.53 / $40.53	Professional	TC	$40.53	$40.53	$40.53