Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $16.82 / $18.35 / $33.93	Facility	26	$16.82	$18.35	$33.93
Aetna Facility/Professional Professional Modifier Low / Median / High Price $37.88 / $79.51 / $130.87	Professional		$37.88	$79.51	$130.87
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.33 / $15.19 / $33.81	Professional	26	$7.33	$15.19	$33.81
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $27.98 / $63.35 / $133.21	Professional	TC	$27.98	$63.35	$133.21
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $23.34 / $24.07 / $26.99	Professional	26	$23.34	$24.07	$26.99
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 $59.14 / $106.91 / $475.98	Professional		$59.14	$106.91	$475.98
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $16.25 / $32.72 / $211.35	Professional	26	$16.25	$32.72	$211.35
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $41.32 / $74.38 / $429.40	Professional	TC	$41.32	$74.38	$429.40
Cigna Facility/Professional Professional Modifier Low / Median / High Price $51.05 / $90.89 / $147.11	Professional		$51.05	$90.89	$147.11
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $9.51 / $20.94 / $44.34	Professional	26	$9.51	$20.94	$44.34
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $36.47 / $67.26 / $104.14	Professional	TC	$36.47	$67.26	$104.14
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $9.77 / $19.18 / $635.38	Facility	26	$9.77	$19.18	$635.38
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $48.67 / $104.08 / $203.87	Professional		$48.67	$104.08	$203.87
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $9.00 / $18.35 / $37.14	Professional	26	$9.00	$18.35	$37.14
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $40.92 / $78.16 / $185.48	Professional	TC	$40.92	$78.16	$185.48
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 $14.25 / $27.14 / $29.48	Facility	26	$14.25	$27.14	$29.48
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $11.75 / $16.50 / $27.14	Professional	26	$11.75	$16.50	$27.14
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $43.60 / $70.20 / $150.96	Professional	TC	$43.60	$70.20	$150.96
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $20.11 / $20.11 / $20.39	Facility	26	$20.11	$20.11	$20.39
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $67.02 / $99.07 / $121.86	Professional		$67.02	$99.07	$121.86
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $21.79 / $34.42 / $41.89	Professional	26	$21.79	$34.42	$41.89
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $43.36 / $65.84 / $79.97	Professional	TC	$43.36	$65.84	$79.97
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $446.45 / $446.45 / $782.93	Facility	26	$446.45	$446.45	$782.93
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $59.14 / $88.06 / $124.16	Professional		$59.14	$88.06	$124.16
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $20.79 / $30.45 / $41.29	Professional	26	$20.79	$30.45	$41.29
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $39.84 / $57.93 / $88.07	Professional	TC	$39.84	$57.93	$88.07
United Facility/Professional Professional Modifier Low / Median / High Price $42.59 / $67.11 / $131.88	Professional		$42.59	$67.11	$131.88
United Facility/Professional Professional Modifier 26 Low / Median / High Price $8.85 / $17.14 / $42.08	Professional	26	$8.85	$17.14	$42.08
United Facility/Professional Professional Modifier TC Low / Median / High Price $26.71 / $50.75 / $89.97	Professional	TC	$26.71	$50.75	$89.97
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $48.71 / $48.71 / $48.71	Professional		$48.71	$48.71	$48.71
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $15.68 / $15.68 / $15.68	Professional	26	$15.68	$15.68	$15.68
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $33.03 / $33.03 / $33.03	Professional	TC	$33.03	$33.03	$33.03