Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $10.63 / $17.39 / $30.88	Facility	26	$10.63	$17.39	$30.88
Aetna Facility/Professional Professional Modifier Low / Median / High Price $28.91 / $40.22 / $89.34	Professional		$28.91	$40.22	$89.34
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.17 / $10.63 / $23.50	Professional	26	$8.17	$10.63	$23.50
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $20.39 / $29.60 / $52.00	Professional	TC	$20.39	$29.60	$52.00
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $26.24 / $62.21 / $88.93	Professional		$26.24	$62.21	$88.93
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 $46.66 / $80.84 / $291.45	Professional		$46.66	$80.84	$291.45
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $12.94 / $23.30 / $77.70	Professional	26	$12.94	$23.30	$77.70
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $33.72 / $57.61 / $213.75	Professional	TC	$33.72	$57.61	$213.75
Cigna Facility/Professional Professional Modifier Low / Median / High Price $31.78 / $59.05 / $108.76	Professional		$31.78	$59.05	$108.76
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.09 / $17.52 / $28.40	Professional	26	$10.09	$17.52	$28.40
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $21.50 / $40.70 / $79.79	Professional	TC	$21.50	$40.70	$79.79
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $9.61 / $21.22 / $236.39	Facility	26	$9.61	$21.22	$236.39
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $29.76 / $63.60 / $89.44	Professional		$29.76	$63.60	$89.44
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $9.61 / $20.42 / $25.72	Professional	26	$9.61	$20.42	$25.72
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $21.08 / $42.09 / $66.70	Professional	TC	$21.08	$42.09	$66.70
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 $15.39 / $18.46 / $19.43	Facility	26	$15.39	$18.46	$19.43
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $11.60 / $17.28 / $21.98	Professional	26	$11.60	$17.28	$21.98
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $22.00 / $36.18 / $54.75	Professional	TC	$22.00	$36.18	$54.75
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $12.68 / $12.68 / $12.80	Facility	26	$12.68	$12.68	$12.80
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $51.88 / $76.98 / $94.67	Professional		$51.88	$76.98	$94.67
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $14.43 / $21.67 / $26.24	Professional	26	$14.43	$21.67	$26.24
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $37.50 / $55.65 / $68.42	Professional	TC	$37.50	$55.65	$68.42
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 $47.19 / $69.19 / $91.09	Professional		$47.19	$69.19	$91.09
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $13.44 / $19.38 / $26.67	Professional	26	$13.44	$19.38	$26.67
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $33.72 / $50.01 / $68.17	Professional	TC	$33.72	$50.01	$68.17
United Facility/Professional Professional Modifier Low / Median / High Price $32.46 / $38.39 / $92.09	Professional		$32.46	$38.39	$92.09
United Facility/Professional Professional Modifier 26 Low / Median / High Price $10.10 / $11.46 / $26.60	Professional	26	$10.10	$11.46	$26.60
United Facility/Professional Professional Modifier TC Low / Median / High Price $22.46 / $28.77 / $69.36	Professional	TC	$22.46	$28.77	$69.36
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $38.08 / $38.08 / $38.08	Professional		$38.08	$38.08	$38.08
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $9.78 / $9.78 / $9.78	Professional	26	$9.78	$9.78	$9.78
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $28.29 / $28.29 / $28.29	Professional	TC	$28.29	$28.29	$28.29