Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $17.17 / $21.01 / $42.29	Facility	26	$17.17	$21.01	$42.29
Aetna Facility/Professional Professional Modifier Low / Median / High Price $43.64 / $59.52 / $134.60	Professional		$43.64	$59.52	$134.60
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $13.58 / $17.39 / $40.00	Professional	26	$13.58	$17.39	$40.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $30.03 / $42.35 / $73.81	Professional	TC	$30.03	$42.35	$73.81
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $39.35 / $93.29 / $93.29	Professional		$39.35	$93.29	$93.29
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $8.61 / $24.72 / $28.01	Professional	26	$8.61	$24.72	$28.01
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 $65.95 / $119.26 / $432.23	Professional		$65.95	$119.26	$432.23
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $20.79 / $36.40 / $128.79	Professional	26	$20.79	$36.40	$128.79
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $48.05 / $81.92 / $306.89	Professional	TC	$48.05	$81.92	$306.89
Cigna Facility/Professional Professional Modifier Low / Median / High Price $47.66 / $87.18 / $161.13	Professional		$47.66	$87.18	$161.13
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $15.99 / $27.76 / $45.55	Professional	26	$15.99	$27.76	$45.55
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $30.81 / $58.93 / $116.60	Professional	TC	$30.81	$58.93	$116.60
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $14.88 / $34.04 / $290.81	Facility	26	$14.88	$34.04	$290.81
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $45.88 / $97.19 / $131.88	Professional		$45.88	$97.19	$131.88
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $14.88 / $32.39 / $41.53	Professional	26	$14.88	$32.39	$41.53
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $31.93 / $61.98 / $94.75	Professional	TC	$31.93	$61.98	$94.75
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 $22.54 / $30.15 / $30.82	Facility	26	$22.54	$30.15	$30.82
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $18.48 / $26.22 / $31.73	Professional	26	$18.48	$26.22	$31.73
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $38.60 / $54.15 / $66.81	Professional	TC	$38.60	$54.15	$66.81
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $20.39 / $20.39 / $20.57	Facility	26	$20.39	$20.39	$20.57
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $75.36 / $114.35 / $140.60	Professional		$75.36	$114.35	$140.60
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $23.71 / $34.83 / $42.84	Professional	26	$23.71	$34.83	$42.84
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $53.10 / $80.04 / $98.42	Professional	TC	$53.10	$80.04	$98.42
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 $68.84 / $102.75 / $134.72	Professional		$68.84	$102.75	$134.72
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $21.60 / $31.14 / $42.31	Professional	26	$21.60	$31.14	$42.31
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $48.05 / $71.93 / $97.13	Professional	TC	$48.05	$71.93	$97.13
United Facility/Professional Professional Modifier Low / Median / High Price $49.01 / $55.91 / $152.16	Professional		$49.01	$55.91	$152.16
United Facility/Professional Professional Modifier 26 Low / Median / High Price $16.12 / $17.77 / $42.16	Professional	26	$16.12	$17.77	$42.16
United Facility/Professional Professional Modifier TC Low / Median / High Price $31.74 / $39.40 / $98.79	Professional	TC	$31.74	$39.40	$98.79
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $57.01 / $57.01 / $57.01	Professional		$57.01	$57.01	$57.01
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 $40.92 / $40.92 / $40.92	Professional	TC	$40.92	$40.92	$40.92