Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $17.17 / $21.64 / $50.64	Facility	26	$17.17	$21.64	$50.64
Aetna Facility/Professional Professional Modifier Low / Median / High Price $47.33 / $62.92 / $132.66	Professional		$47.33	$62.92	$132.66
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $13.58 / $17.17 / $37.90	Professional	26	$13.58	$17.17	$37.90
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $33.04 / $45.75 / $80.81	Professional	TC	$33.04	$45.75	$80.81
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $41.16 / $110.57 / $110.57	Professional		$41.16	$110.57	$110.57
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $8.61 / $23.97 / $24.72	Professional	26	$8.61	$23.97	$24.72
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 $72.53 / $126.50 / $455.55	Professional		$72.53	$126.50	$455.55
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $20.79 / $36.77 / $128.25	Professional	26	$20.79	$36.77	$128.25
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $51.74 / $88.40 / $327.23	Professional	TC	$51.74	$88.40	$327.23
Cigna Facility/Professional Professional Modifier Low / Median / High Price $51.51 / $94.56 / $170.06	Professional		$51.51	$94.56	$170.06
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $16.34 / $28.13 / $46.60	Professional	26	$16.34	$28.13	$46.60
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $34.29 / $66.19 / $124.60	Professional	TC	$34.29	$66.19	$124.60
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $15.50 / $34.36 / $290.81	Facility	26	$15.50	$34.36	$290.81
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $50.22 / $102.55 / $139.47	Professional		$50.22	$102.55	$139.47
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $15.50 / $33.04 / $42.01	Professional	26	$15.50	$33.04	$42.01
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $35.96 / $66.58 / $102.33	Professional	TC	$35.96	$66.58	$102.33
Molina Facility/Professional Professional Modifier Low / Median / High Price $9.16 / $54.50 / $92.81	Professional		$9.16	$54.50	$92.81
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $25.28 / $30.23 / $31.28	Facility	26	$25.28	$30.23	$31.28
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $18.89 / $27.60 / $34.04	Professional	26	$18.89	$27.60	$34.04
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $40.52 / $60.99 / $77.34	Professional	TC	$40.52	$60.99	$77.34
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $20.39 / $20.39 / $21.02	Facility	26	$20.39	$20.39	$21.02
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $81.16 / $120.44 / $148.09	Professional		$81.16	$120.44	$148.09
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $23.63 / $35.32 / $43.78	Professional	26	$23.63	$35.32	$43.78
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $55.78 / $85.38 / $104.98	Professional	TC	$55.78	$85.38	$104.98
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 $72.53 / $108.23 / $141.91	Professional		$72.53	$108.23	$141.91
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $21.60 / $31.51 / $43.23	Professional	26	$21.60	$31.51	$43.23
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $51.74 / $76.72 / $104.60	Professional	TC	$51.74	$76.72	$104.60
United Facility/Professional Professional Modifier Low / Median / High Price $51.58 / $58.89 / $144.04	Professional		$51.58	$58.89	$144.04
United Facility/Professional Professional Modifier 26 Low / Median / High Price $16.09 / $18.37 / $45.46	Professional	26	$16.09	$18.37	$45.46
United Facility/Professional Professional Modifier TC Low / Median / High Price $35.36 / $41.74 / $102.10	Professional	TC	$35.36	$41.74	$102.10
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $59.77 / $59.77 / $59.77	Professional		$59.77	$59.77	$59.77
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $16.07 / $16.07 / $16.07	Professional	26	$16.07	$16.07	$16.07
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $43.68 / $43.68 / $43.68	Professional	TC	$43.68	$43.68	$43.68