Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $16.75 / $28.02 / $55.55	Facility	26	$16.75	$28.02	$55.55
Aetna Facility/Professional Professional Modifier Low / Median / High Price $37.25 / $61.46 / $118.34	Professional		$37.25	$61.46	$118.34
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $13.13 / $16.75 / $42.29	Professional	26	$13.13	$16.75	$42.29
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $23.27 / $45.52 / $80.63	Professional	TC	$23.27	$45.52	$80.63
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $8.43 / $24.16 / $25.10	Professional	26	$8.43	$24.16	$25.10
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 $55.90 / $99.45 / $390.88	Professional		$55.90	$99.45	$390.88
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $20.39 / $36.77 / $125.40	Professional	26	$20.39	$36.77	$125.40
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $36.10 / $66.42 / $301.75	Professional	TC	$36.10	$66.42	$301.75
Cigna Facility/Professional Professional Modifier Low / Median / High Price $45.12 / $82.16 / $133.53	Professional		$45.12	$82.16	$133.53
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $15.99 / $27.51 / $45.55	Professional	26	$15.99	$27.51	$45.55
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $26.04 / $53.69 / $88.98	Professional	TC	$26.04	$53.69	$88.98
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $14.88 / $34.04 / $1,002.46	Facility	26	$14.88	$34.04	$1,002.46
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $38.47 / $83.41 / $166.29	Professional		$38.47	$83.41	$166.29
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $14.88 / $32.39 / $41.16	Professional	26	$14.88	$32.39	$41.16
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $24.49 / $51.98 / $130.31	Professional	TC	$24.49	$51.98	$130.31
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 $24.73 / $29.57 / $30.60	Facility	26	$24.73	$29.57	$30.60
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $17.69 / $25.96 / $33.52	Professional	26	$17.69	$25.96	$33.52
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $27.34 / $43.80 / $77.72	Professional	TC	$27.34	$43.80	$77.72
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $19.93 / $19.93 / $20.57	Facility	26	$19.93	$19.93	$20.57
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $63.92 / $96.53 / $118.05	Professional		$63.92	$96.53	$118.05
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $23.23 / $34.56 / $42.84	Professional	26	$23.23	$34.56	$42.84
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $40.72 / $61.15 / $75.20	Professional	TC	$40.72	$61.15	$75.20
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $714.15 / $714.15 / $851.78	Facility	26	$714.15	$714.15	$851.78
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $55.90 / $84.94 / $113.95	Professional		$55.90	$84.94	$113.95
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $21.12 / $30.83 / $42.31	Professional	26	$21.12	$30.83	$42.31
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $35.57 / $54.12 / $73.78	Professional	TC	$35.57	$54.12	$73.78
United Facility/Professional Professional Modifier Low / Median / High Price $40.78 / $64.61 / $125.80	Professional		$40.78	$64.61	$125.80
United Facility/Professional Professional Modifier 26 Low / Median / High Price $16.23 / $17.87 / $42.75	Professional	26	$16.23	$17.87	$42.75
United Facility/Professional Professional Modifier TC Low / Median / High Price $24.54 / $35.36 / $75.05	Professional	TC	$24.54	$35.36	$75.05
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $46.75 / $46.75 / $46.75	Professional		$46.75	$46.75	$46.75
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $15.69 / $15.69 / $15.69	Professional	26	$15.69	$15.69	$15.69
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $31.06 / $31.06 / $31.06	Professional	TC	$31.06	$31.06	$31.06