Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $15.26 / $24.91 / $48.65	Facility	26	$15.26	$24.91	$48.65
Aetna Facility/Professional Professional Modifier Low / Median / High Price $39.97 / $58.05 / $116.26	Professional		$39.97	$58.05	$116.26
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.69 / $15.27 / $33.54	Professional	26	$11.69	$15.27	$33.54
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $27.87 / $42.77 / $74.98	Professional	TC	$27.87	$42.77	$74.98
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $37.34 / $37.34 / $37.34	Professional		$37.34	$37.34	$37.34
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $22.11 / $22.11 / $22.11	Professional	26	$22.11	$22.11	$22.11
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 $65.70 / $115.49 / $438.00	Professional		$65.70	$115.49	$438.00
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $18.48 / $32.38 / $110.63	Professional	26	$18.48	$32.38	$110.63
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $45.50 / $81.17 / $423.00	Professional	TC	$45.50	$81.17	$423.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $43.66 / $81.03 / $155.43	Professional		$43.66	$81.03	$155.43
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $14.28 / $24.66 / $40.69	Professional	26	$14.28	$24.66	$40.69
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $30.42 / $55.87 / $115.13	Professional	TC	$30.42	$55.87	$115.13
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $13.33 / $30.32 / $290.81	Facility	26	$13.33	$30.32	$290.81
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $41.92 / $88.70 / $127.34	Professional		$41.92	$88.70	$127.34
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $13.33 / $28.82 / $36.86	Professional	26	$13.33	$28.82	$36.86
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $28.83 / $60.20 / $93.70	Professional	TC	$28.83	$60.20	$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 $20.09 / $26.46 / $26.80	Facility	26	$20.09	$26.46	$26.80
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $18.45 / $24.74 / $30.60	Professional	26	$18.45	$24.74	$30.60
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $37.99 / $51.75 / $69.55	Professional	TC	$37.99	$51.75	$69.55
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $18.12 / $18.12 / $18.28	Facility	26	$18.12	$18.12	$18.28
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $72.83 / $110.67 / $134.97	Professional		$72.83	$110.67	$134.97
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $20.62 / $30.96 / $37.49	Professional	26	$20.62	$30.96	$37.49
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $51.69 / $79.28 / $97.48	Professional	TC	$51.69	$79.28	$97.48
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 $66.98 / $98.64 / $130.78	Professional		$66.98	$98.64	$130.78
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $19.20 / $27.68 / $37.71	Professional	26	$19.20	$27.68	$37.71
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $48.51 / $71.23 / $97.13	Professional	TC	$48.51	$71.23	$97.13
United Facility/Professional Professional Modifier Low / Median / High Price $43.64 / $53.68 / $129.47	Professional		$43.64	$53.68	$129.47
United Facility/Professional Professional Modifier 26 Low / Median / High Price $14.07 / $15.85 / $37.99	Professional	26	$14.07	$15.85	$37.99
United Facility/Professional Professional Modifier TC Low / Median / High Price $30.94 / $38.77 / $94.84	Professional	TC	$30.94	$38.77	$94.84
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $54.59 / $54.59 / $54.59	Professional		$54.59	$54.59	$54.59
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $14.06 / $14.06 / $14.06	Professional	26	$14.06	$14.06	$14.06
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $40.53 / $40.53 / $40.53	Professional	TC	$40.53	$40.53	$40.53