Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $13.74 / $21.86 / $37.71	Facility	26	$13.74	$21.86	$37.71
Aetna Facility/Professional Professional Modifier Low / Median / High Price $37.92 / $50.14 / $100.28	Professional		$37.92	$50.14	$100.28
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $9.75 / $13.74 / $27.48	Professional	26	$9.75	$13.74	$27.48
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $26.83 / $36.40 / $70.47	Professional	TC	$26.83	$36.40	$70.47
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $32.95 / $69.25 / $69.25	Professional		$32.95	$69.25	$69.25
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $6.66 / $20.89 / $20.89	Professional	26	$6.66	$20.89	$20.89
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 $56.74 / $100.75 / $365.85	Professional		$56.74	$100.75	$365.85
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $16.63 / $28.50 / $99.75	Professional	26	$16.63	$28.50	$99.75
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $41.58 / $72.04 / $266.10	Professional	TC	$41.58	$72.04	$266.10
Cigna Facility/Professional Professional Modifier Low / Median / High Price $39.42 / $75.55 / $136.94	Professional		$39.42	$75.55	$136.94
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.28 / $20.28 / $36.61	Professional	26	$11.28	$20.28	$36.61
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $27.75 / $53.54 / $101.17	Professional	TC	$27.75	$53.54	$101.17
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $11.26 / $22.94 / $290.81	Facility	26	$11.26	$22.94	$290.81
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $41.23 / $80.26 / $112.18	Professional		$41.23	$80.26	$112.18
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $10.32 / $21.98 / $30.87	Professional	26	$10.32	$21.98	$30.87
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $31.00 / $58.92 / $82.62	Professional	TC	$31.00	$58.92	$82.62
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 $16.66 / $22.44 / $24.12	Facility	26	$16.66	$22.44	$24.12
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $14.14 / $19.35 / $24.12	Professional	26	$14.14	$19.35	$24.12
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $32.92 / $49.40 / $59.94	Professional	TC	$32.92	$49.40	$59.94
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $16.30 / $16.30 / $16.45	Facility	26	$16.30	$16.30	$16.45
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $62.47 / $96.81 / $119.04	Professional		$62.47	$96.81	$119.04
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $18.05 / $27.86 / $33.74	Professional	26	$18.05	$27.86	$33.74
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $44.76 / $69.37 / $85.29	Professional	TC	$44.76	$69.37	$85.29
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 $58.21 / $87.00 / $114.07	Professional		$58.21	$87.00	$114.07
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $16.96 / $24.74 / $33.61	Professional	26	$16.96	$24.74	$33.61
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $41.58 / $62.34 / $84.75	Professional	TC	$41.58	$62.34	$84.75
United Facility/Professional Professional Modifier Low / Median / High Price $38.95 / $46.86 / $120.66	Professional		$38.95	$46.86	$120.66
United Facility/Professional Professional Modifier 26 Low / Median / High Price $11.23 / $14.29 / $34.65	Professional	26	$11.23	$14.29	$34.65
United Facility/Professional Professional Modifier TC Low / Median / High Price $28.13 / $33.92 / $82.97	Professional	TC	$28.13	$33.92	$82.97
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $48.05 / $48.05 / $48.05	Professional		$48.05	$48.05	$48.05
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $12.66 / $12.66 / $12.66	Professional	26	$12.66	$12.66	$12.66
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $35.40 / $35.40 / $35.40	Professional	TC	$35.40	$35.40	$35.40