Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $11.78 / $19.25 / $38.86	Facility	26	$11.78	$19.25	$38.86
Aetna Facility/Professional Professional Modifier Low / Median / High Price $34.50 / $49.89 / $100.68	Professional		$34.50	$49.89	$100.68
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.84 / $11.79 / $23.73	Professional	26	$8.84	$11.79	$23.73
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $25.71 / $38.10 / $70.77	Professional	TC	$25.71	$38.10	$70.77
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 $56.17 / $99.25 / $357.83	Professional		$56.17	$99.25	$357.83
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $14.32 / $25.35 / $85.95	Professional	26	$14.32	$25.35	$85.95
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $42.97 / $72.13 / $271.95	Professional	TC	$42.97	$72.13	$271.95
Cigna Facility/Professional Professional Modifier Low / Median / High Price $37.22 / $69.31 / $134.09	Professional		$37.22	$69.31	$134.09
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.14 / $19.34 / $31.47	Professional	26	$11.14	$19.34	$31.47
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $27.16 / $49.39 / $101.72	Professional	TC	$27.16	$49.39	$101.72
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $13.02 / $23.49 / $236.39	Facility	26	$13.02	$23.49	$236.39
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $35.67 / $75.06 / $109.91	Professional		$35.67	$75.06	$109.91
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $11.78 / $22.74 / $28.29	Professional	26	$11.78	$22.74	$28.29
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $25.42 / $53.25 / $83.22	Professional	TC	$25.42	$53.25	$83.22
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 / $21.44	Facility	26	$17.04	$20.46	$21.44
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $12.86 / $18.60 / $23.34	Professional	26	$12.86	$18.60	$23.34
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $31.46 / $44.16 / $55.67	Professional	TC	$31.46	$44.16	$55.67
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 $61.00 / $94.97 / $116.23	Professional		$61.00	$94.97	$116.23
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $15.98 / $23.99 / $29.06	Professional	26	$15.98	$23.99	$29.06
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $45.75 / $70.89 / $87.17	Professional	TC	$45.75	$70.89	$87.17
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 $57.29 / $84.94 / $111.84	Professional		$57.29	$84.94	$111.84
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $14.88 / $21.45 / $29.43	Professional	26	$14.88	$21.45	$29.43
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $42.97 / $63.71 / $86.85	Professional	TC	$42.97	$63.71	$86.85
United Facility/Professional Professional Modifier Low / Median / High Price $37.15 / $46.22 / $113.05	Professional		$37.15	$46.22	$113.05
United Facility/Professional Professional Modifier 26 Low / Median / High Price $11.18 / $12.71 / $29.46	Professional	26	$11.18	$12.71	$29.46
United Facility/Professional Professional Modifier TC Low / Median / High Price $26.00 / $34.65 / $84.77	Professional	TC	$26.00	$34.65	$84.77
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $47.04 / $47.04 / $47.04	Professional		$47.04	$47.04	$47.04
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 $36.19 / $36.19 / $36.19	Professional	TC	$36.19	$36.19	$36.19