Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $14.07 / $21.82 / $37.78	Facility	26	$14.07	$21.82	$37.78
Aetna Facility/Professional Professional Modifier Low / Median / High Price $29.74 / $44.12 / $155.19	Professional		$29.74	$44.12	$155.19
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.11 / $15.02 / $34.50	Professional	26	$10.11	$15.02	$34.50
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $18.72 / $26.48 / $45.61	Professional	TC	$18.72	$26.48	$45.61
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $49.90 / $56.85 / $63.77	Professional		$49.90	$56.85	$63.77
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $50.00 / $70.00 / $70.00	Facility	26	$50.00	$70.00	$70.00
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $42.04 / $71.13 / $264.98	Professional		$42.04	$71.13	$264.98
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $14.32 / $25.73 / $86.18	Professional	26	$14.32	$25.73	$86.18
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $27.72 / $44.96 / $178.80	Professional	TC	$27.72	$44.96	$178.80
Cigna Facility/Professional Professional Modifier Low / Median / High Price $37.39 / $63.09 / $102.79	Professional		$37.39	$63.09	$102.79
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.71 / $21.69 / $34.54	Professional	26	$12.71	$21.69	$34.54
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $23.39 / $39.81 / $67.70	Professional	TC	$23.39	$39.81	$67.70
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $13.45 / $26.97 / $395.70	Facility	26	$13.45	$26.97	$395.70
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $39.36 / $75.19 / $99.37	Professional		$39.36	$75.19	$99.37
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $13.14 / $25.89 / $35.86	Professional	26	$13.14	$25.89	$35.86
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $25.88 / $47.97 / $66.03	Professional	TC	$25.88	$47.97	$66.03
Molina Facility/Professional Professional Modifier Low / Median / High Price $9.16 / $54.85 / $92.98	Professional		$9.16	$54.85	$92.98
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $17.04 / $20.45 / $26.13	Facility	26	$17.04	$20.45	$26.13
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $13.63 / $18.29 / $26.13	Professional	26	$13.63	$18.29	$26.13
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $31.92 / $34.84 / $46.90	Professional	TC	$31.92	$34.84	$46.90
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $14.04 / $14.04 / $14.17	Facility	26	$14.04	$14.04	$14.17
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $46.91 / $71.68 / $87.58	Professional		$46.91	$71.68	$87.58
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $15.92 / $24.38 / $29.51	Professional	26	$15.92	$24.38	$29.51
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $30.93 / $47.21 / $58.03	Professional	TC	$30.93	$47.21	$58.03
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $270.73 / $270.73 / $459.43	Facility	26	$270.73	$270.73	$459.43
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $42.04 / $60.25 / $82.80	Professional		$42.04	$60.25	$82.80
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $14.32 / $20.38 / $29.09	Professional	26	$14.32	$20.38	$29.09
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $27.72 / $39.72 / $54.79	Professional	TC	$27.72	$39.72	$54.79
United Facility/Professional Professional Modifier Low / Median / High Price $37.89 / $62.99 / $99.98	Professional		$37.89	$62.99	$99.98
United Facility/Professional Professional Modifier 26 Low / Median / High Price $14.44 / $23.61 / $37.68	Professional	26	$14.44	$23.61	$37.68
United Facility/Professional Professional Modifier TC Low / Median / High Price $24.58 / $39.25 / $62.38	Professional	TC	$24.58	$39.25	$62.38
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $34.47 / $34.47 / $34.47	Professional		$34.47	$34.47	$34.47
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $10.91 / $10.91 / $10.91	Professional	26	$10.91	$10.91	$10.91
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $23.56 / $23.56 / $23.56	Professional	TC	$23.56	$23.56	$23.56