Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $11.78 / $16.00 / $34.82	Facility	26	$11.78	$16.00	$34.82
Aetna Facility/Professional Professional Modifier Low / Median / High Price $33.84 / $45.21 / $103.50	Professional		$33.84	$45.21	$103.50
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $9.66 / $12.35 / $29.30	Professional	26	$9.66	$12.35	$29.30
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $24.16 / $33.42 / $65.90	Professional	TC	$24.16	$33.42	$65.90
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $29.59 / $70.37 / $99.89	Professional		$29.59	$70.37	$99.89
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $14.67 / $16.19 / $17.92	Professional	26	$14.67	$16.19	$17.92
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 $52.21 / $91.43 / $325.88	Professional		$52.21	$91.43	$325.88
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $14.32 / $25.09 / $107.32	Professional	26	$14.32	$25.09	$107.32
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $37.88 / $65.16 / $249.00	Professional	TC	$37.88	$65.16	$249.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $38.42 / $68.47 / $121.82	Professional		$38.42	$68.47	$121.82
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.04 / $20.96 / $31.47	Professional	26	$12.04	$20.96	$31.47
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $26.94 / $48.32 / $91.14	Professional	TC	$26.94	$48.32	$91.14
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $13.50 / $25.30 / $236.39	Facility	26	$13.50	$25.30	$236.39
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $36.92 / $78.30 / $105.81	Professional		$36.92	$78.30	$105.81
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $13.02 / $24.17 / $31.44	Professional	26	$13.02	$24.17	$31.44
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $25.73 / $54.02 / $75.04	Professional	TC	$25.73	$54.02	$75.04
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 $17.04 / $20.46 / $24.12	Facility	26	$17.04	$20.46	$24.12
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $14.47 / $20.88 / $25.20	Professional	26	$14.47	$20.88	$25.20
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $31.76 / $45.03 / $54.77	Professional	TC	$31.76	$45.03	$54.77
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $14.04 / $14.04 / $14.17	Facility	26	$14.04	$14.04	$14.17
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $58.25 / $86.34 / $105.91	Professional		$58.25	$86.34	$105.91
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $15.98 / $24.06 / $29.06	Professional	26	$15.98	$24.06	$29.06
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $42.27 / $62.51 / $76.86	Professional	TC	$42.27	$62.51	$76.86
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 $52.21 / $77.40 / $101.92	Professional		$52.21	$77.40	$101.92
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $14.88 / $21.45 / $31.82	Professional	26	$14.88	$21.45	$31.82
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $37.88 / $56.17 / $76.58	Professional	TC	$37.88	$56.17	$76.58
United Facility/Professional Professional Modifier Low / Median / High Price $37.17 / $42.12 / $107.34	Professional		$37.17	$42.12	$107.34
United Facility/Professional Professional Modifier 26 Low / Median / High Price $11.55 / $12.89 / $29.46	Professional	26	$11.55	$12.89	$29.46
United Facility/Professional Professional Modifier TC Low / Median / High Price $25.62 / $32.09 / $74.73	Professional	TC	$25.62	$32.09	$74.73
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $43.10 / $43.10 / $43.10	Professional		$43.10	$43.10	$43.10
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $10.86 / $10.86 / $10.86	Professional	26	$10.86	$10.86	$10.86
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $32.24 / $32.24 / $32.24	Professional	TC	$32.24	$32.24	$32.24