Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $20.66 / $32.22 / $41.68	Facility	26	$20.66	$32.22	$41.68
Aetna Facility/Professional Professional Modifier Low / Median / High Price $26.23 / $50.33 / $78.58	Professional		$26.23	$50.33	$78.58
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $13.75 / $19.79 / $36.04	Professional	26	$13.75	$19.79	$36.04
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $12.47 / $31.46 / $56.30	Professional	TC	$12.47	$31.46	$56.30
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $29.36 / $70.00 / $80.00	Facility	26	$29.36	$70.00	$80.00
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $55.76 / $104.49 / $387.90	Professional		$55.76	$104.49	$387.90
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $19.64 / $33.04 / $118.80	Professional	26	$19.64	$33.04	$118.80
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $36.71 / $70.97 / $269.02	Professional	TC	$36.71	$70.97	$269.02
Cigna Facility/Professional Professional Modifier Low / Median / High Price $34.53 / $74.00 / $156.31	Professional		$34.53	$74.00	$156.31
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $16.13 / $27.15 / $47.65	Professional	26	$16.13	$27.15	$47.65
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $16.48 / $50.83 / $108.66	Professional	TC	$16.48	$50.83	$108.66
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $13.33 / $18.95 / $34.60	Facility	26	$13.33	$18.95	$34.60
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $24.96 / $38.67 / $73.28	Professional		$24.96	$38.67	$73.28
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $13.33 / $19.68 / $34.70	Professional	26	$13.33	$19.68	$34.70
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $11.26 / $17.82 / $42.77	Professional	TC	$11.26	$17.82	$42.77
Molina Facility/Professional Professional Modifier Low / Median / High Price $9.16 / $50.15 / $91.10	Professional		$9.16	$50.15	$91.10
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $23.64 / $28.46 / $29.48	Facility	26	$23.64	$28.46	$29.48
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $17.29 / $23.80 / $30.53	Professional	26	$17.29	$23.80	$30.53
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $15.75 / $21.59 / $59.23	Professional	TC	$15.75	$21.59	$59.23
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $19.64 / $19.93 / $19.93	Facility	26	$19.64	$19.93	$19.93
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $67.43 / $102.91 / $122.46	Professional		$67.43	$102.91	$122.46
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $22.09 / $32.18 / $39.01	Professional	26	$22.09	$32.18	$39.01
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $45.95 / $69.06 / $83.45	Professional	TC	$45.95	$69.06	$83.45
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $56.12 / $81.81 / $114.54	Professional		$56.12	$81.81	$114.54
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $20.32 / $26.88 / $36.38	Professional	26	$20.32	$26.88	$36.38
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $38.64 / $55.75 / $77.52	Professional	TC	$38.64	$55.75	$77.52
United Facility/Professional Professional Modifier Low / Median / High Price $36.96 / $59.50 / $120.90	Professional		$36.96	$59.50	$120.90
United Facility/Professional Professional Modifier 26 Low / Median / High Price $17.20 / $23.24 / $42.24	Professional	26	$17.20	$23.24	$42.24
United Facility/Professional Professional Modifier TC Low / Median / High Price $16.32 / $39.90 / $86.60	Professional	TC	$16.32	$39.90	$86.60
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $36.72 / $50.53 / $50.53	Professional		$36.72	$50.53	$50.53
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $11.87 / $15.13 / $15.13	Professional	26	$11.87	$15.13	$15.13
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $24.84 / $35.40 / $35.40	Professional	TC	$24.84	$35.40	$35.40