Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $12.21 / $19.89 / $38.86	Facility	26	$12.21	$19.89	$38.86
Aetna Facility/Professional Professional Modifier Low / Median / High Price $39.22 / $53.45 / $111.41	Professional		$39.22	$53.45	$111.41
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $9.59 / $12.21 / $28.90	Professional	26	$9.59	$12.21	$28.90
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $27.63 / $41.42 / $75.37	Professional	TC	$27.63	$41.42	$75.37
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $76.02 / $76.02 / $108.12	Professional		$76.02	$76.02	$108.12
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $8.48 / $18.55 / $18.55	Professional	26	$8.48	$18.55	$18.55
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 $56.36 / $98.39 / $352.05	Professional		$56.36	$98.39	$352.05
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $14.78 / $25.15 / $117.24	Professional	26	$14.78	$25.15	$117.24
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $41.58 / $72.84 / $263.25	Professional	TC	$41.58	$72.84	$263.25
Cigna Facility/Professional Professional Modifier Low / Median / High Price $44.88 / $76.88 / $131.86	Professional		$44.88	$76.88	$131.86
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.14 / $19.57 / $32.52	Professional	26	$11.14	$19.57	$32.52
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $33.11 / $58.28 / $100.06	Professional	TC	$33.11	$58.28	$100.06
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $10.85 / $23.98 / $290.81	Facility	26	$10.85	$23.98	$290.81
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $40.36 / $85.84 / $118.13	Professional		$40.36	$85.84	$118.13
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $10.85 / $23.03 / $29.86	Professional	26	$10.85	$23.03	$29.86
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $29.72 / $62.51 / $91.13	Professional	TC	$29.72	$62.51	$91.13
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 $17.14 / $21.12 / $21.76	Facility	26	$17.14	$21.12	$21.76
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $12.86 / $20.30 / $24.00	Professional	26	$12.86	$20.30	$24.00
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $32.96 / $54.94 / $69.62	Professional	TC	$32.96	$54.94	$69.62
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $14.50 / $14.50 / $14.62	Facility	26	$14.50	$14.50	$14.62
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $62.89 / $94.43 / $114.35	Professional		$62.89	$94.43	$114.35
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $16.44 / $24.77 / $29.99	Professional	26	$16.44	$24.77	$29.99
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $46.40 / $68.61 / $84.81	Professional	TC	$46.40	$68.61	$84.81
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 $56.36 / $83.57 / $110.03	Professional		$56.36	$83.57	$110.03
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $15.36 / $22.14 / $29.88	Professional	26	$15.36	$22.14	$29.88
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $41.87 / $62.28 / $84.05	Professional	TC	$41.87	$62.28	$84.05
United Facility/Professional Professional Modifier Low / Median / High Price $40.06 / $48.73 / $109.70	Professional		$40.06	$48.73	$109.70
United Facility/Professional Professional Modifier 26 Low / Median / High Price $11.18 / $12.64 / $30.61	Professional	26	$11.18	$12.64	$30.61
United Facility/Professional Professional Modifier TC Low / Median / High Price $28.51 / $36.79 / $78.06	Professional	TC	$28.51	$36.79	$78.06
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $46.65 / $46.65 / $46.65	Professional		$46.65	$46.65	$46.65
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $11.25 / $11.25 / $11.25	Professional	26	$11.25	$11.25	$11.25
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $35.40 / $35.40 / $35.40	Professional	TC	$35.40	$35.40	$35.40