Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $20.07 / $31.27 / $43.60	Facility	26	$20.07	$31.27	$43.60
Aetna Facility/Professional Professional Modifier Low / Median / High Price $50.92 / $68.14 / $141.04	Professional		$50.92	$68.14	$141.04
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $15.48 / $19.30 / $41.35	Professional	26	$15.48	$19.30	$41.35
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $35.45 / $48.84 / $99.66	Professional	TC	$35.45	$48.84	$99.66
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $28.04 / $70.00 / $80.00	Facility	26	$28.04	$70.00	$80.00
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $64.00 / $101.59 / $541.00	Professional		$64.00	$101.59	$541.00
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $19.19 / $31.96 / $115.65	Professional	26	$19.19	$31.96	$115.65
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $42.34 / $72.52 / $263.25	Professional	TC	$42.34	$72.52	$263.25
Cigna Facility/Professional Professional Modifier Low / Median / High Price $54.45 / $92.63 / $148.16	Professional		$54.45	$92.63	$148.16
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $16.02 / $26.72 / $46.36	Professional	26	$16.02	$26.72	$46.36
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $38.34 / $66.70 / $100.55	Professional	TC	$38.34	$66.70	$100.55
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $13.95 / $20.07 / $40.04	Facility	26	$13.95	$20.07	$40.04
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $48.67 / $71.44 / $127.12	Professional		$48.67	$71.44	$127.12
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $13.64 / $20.04 / $36.77	Professional	26	$13.64	$20.04	$36.77
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $35.03 / $51.36 / $90.34	Professional	TC	$35.03	$51.36	$90.34
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 $22.54 / $27.15 / $30.15	Facility	26	$22.54	$27.15	$30.15
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $17.29 / $24.33 / $30.80	Professional	26	$17.29	$24.33	$30.80
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $39.40 / $57.17 / $73.98	Professional	TC	$39.40	$57.17	$73.98
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $19.19 / $19.48 / $19.48	Facility	26	$19.19	$19.48	$19.48
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $69.41 / $101.77 / $124.53	Professional		$69.41	$101.77	$124.53
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $21.58 / $31.43 / $38.10	Professional	26	$21.58	$31.43	$38.10
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $47.32 / $69.66 / $85.68	Professional	TC	$47.32	$69.66	$85.68
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $72.06 / $72.06 / $127.19	Facility	26	$72.06	$72.06	$127.19
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $65.06 / $85.55 / $114.31	Professional		$65.06	$85.55	$114.31
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $19.87 / $26.42 / $35.54	Professional	26	$19.87	$26.42	$35.54
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $44.78 / $58.54 / $78.02	Professional	TC	$44.78	$58.54	$78.02
United Facility/Professional Professional Modifier Low / Median / High Price $60.84 / $87.98 / $146.65	Professional		$60.84	$87.98	$146.65
United Facility/Professional Professional Modifier 26 Low / Median / High Price $17.60 / $24.44 / $41.29	Professional	26	$17.60	$24.44	$41.29
United Facility/Professional Professional Modifier TC Low / Median / High Price $41.34 / $60.88 / $97.00	Professional	TC	$41.34	$60.88	$97.00
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $34.22 / $46.92 / $46.92	Professional		$34.22	$46.92	$46.92
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $11.32 / $14.29 / $14.29	Professional	26	$11.32	$14.29	$14.29
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $32.64 / $32.64 / $47.00	Professional	TC	$32.64	$32.64	$47.00