Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $12.95 / $25.32 / $43.92	Facility	26	$12.95	$25.32	$43.92
Aetna Facility/Professional Professional Modifier Low / Median / High Price $43.78 / $64.65 / $135.77	Professional		$43.78	$64.65	$135.77
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $9.93 / $12.95 / $28.39	Professional	26	$9.93	$12.95	$28.39
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $33.15 / $51.70 / $93.17	Professional	TC	$33.15	$51.70	$93.17
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $41.47 / $41.47 / $41.47	Professional		$41.47	$41.47	$41.47
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $16.53 / $18.32 / $18.32	Professional	26	$16.53	$18.32	$18.32
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 $72.66 / $128.07 / $459.23	Professional		$72.66	$128.07	$459.23
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $15.71 / $26.78 / $142.00	Professional	26	$15.71	$26.78	$142.00
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $57.13 / $98.46 / $365.10	Professional	TC	$57.13	$98.46	$365.10
Cigna Facility/Professional Professional Modifier Low / Median / High Price $47.58 / $88.88 / $172.81	Professional		$47.58	$88.88	$172.81
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.19 / $21.27 / $34.54	Professional	26	$12.19	$21.27	$34.54
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $36.50 / $67.78 / $139.10	Professional	TC	$36.50	$67.78	$139.10
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $11.47 / $25.77 / $236.39	Facility	26	$11.47	$25.77	$236.39
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $46.62 / $97.15 / $141.74	Professional		$46.62	$97.15	$141.74
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $11.47 / $24.95 / $31.38	Professional	26	$11.47	$24.95	$31.38
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $35.04 / $72.75 / $112.85	Professional	TC	$35.04	$72.75	$112.85
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 $18.69 / $22.46 / $24.12	Facility	26	$18.69	$22.46	$24.12
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $14.47 / $21.60 / $26.64	Professional	26	$14.47	$21.60	$26.64
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $45.60 / $61.28 / $83.66	Professional	TC	$45.60	$61.28	$83.66
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $15.40 / $15.40 / $15.54	Facility	26	$15.40	$15.40	$15.54
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $78.20 / $122.44 / $149.03	Professional		$78.20	$122.44	$149.03
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $17.53 / $26.32 / $32.36	Professional	26	$17.53	$26.32	$32.36
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $63.21 / $95.76 / $117.16	Professional	TC	$63.21	$95.76	$117.16
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 $73.92 / $108.92 / $144.31	Professional		$73.92	$108.92	$144.31
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $16.32 / $23.53 / $32.19	Professional	26	$16.32	$23.53	$32.19
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $58.21 / $85.63 / $116.74	Professional	TC	$58.21	$85.63	$116.74
United Facility/Professional Professional Modifier Low / Median / High Price $48.05 / $59.27 / $144.96	Professional		$48.05	$59.27	$144.96
United Facility/Professional Professional Modifier 26 Low / Median / High Price $12.27 / $13.82 / $32.79	Professional	26	$12.27	$13.82	$32.79
United Facility/Professional Professional Modifier TC Low / Median / High Price $37.25 / $45.82 / $113.97	Professional	TC	$37.25	$45.82	$113.97
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $61.13 / $61.13 / $61.13	Professional		$61.13	$61.13	$61.13
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $11.92 / $11.92 / $11.92	Professional	26	$11.92	$11.92	$11.92
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $49.21 / $49.21 / $49.21	Professional	TC	$49.21	$49.21	$49.21