Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $4.62 / $4.87 / $15.31	Facility	26	$4.62	$4.87	$15.31
Aetna Facility/Professional Professional Modifier Low / Median / High Price $14.50 / $24.71 / $38.40	Professional		$14.50	$24.71	$38.40
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $2.68 / $5.00 / $10.40	Professional	26	$2.68	$5.00	$10.40
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $11.61 / $19.80 / $30.80	Professional	TC	$11.61	$19.80	$30.80
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $2.52 / $2.52 / $2.52	Professional	26	$2.52	$2.52	$2.52
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $5.08 / $100.00 / $100.00	Facility	26	$5.08	$100.00	$100.00
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $20.79 / $34.65 / $161.00	Professional		$20.79	$34.65	$161.00
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $3.98 / $7.08 / $54.00	Professional	26	$3.98	$7.08	$54.00
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $16.63 / $27.72 / $129.00	Professional	TC	$16.63	$27.72	$129.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $19.17 / $33.79 / $53.08	Professional		$19.17	$33.79	$53.08
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $3.63 / $6.62 / $10.14	Professional	26	$3.63	$6.62	$10.14
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $15.28 / $26.89 / $43.52	Professional	TC	$15.28	$26.89	$43.52
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $4.80 / $7.80 / $14.08	Facility	26	$4.80	$7.80	$14.08
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $21.51 / $35.99 / $60.45	Professional		$21.51	$35.99	$60.45
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $4.48 / $7.49 / $12.65	Professional	26	$4.48	$7.49	$12.65
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $17.01 / $29.86 / $48.21	Professional	TC	$17.01	$29.86	$48.21
Molina Facility/Professional Professional Modifier Low / Median / High Price $1.53 / $8.20 / $10.09	Professional		$1.53	$8.20	$10.09
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $4.38 / $5.36 / $10.72	Facility	26	$4.38	$5.36	$10.72
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $5.36 / $7.75 / $10.72	Professional	26	$5.36	$7.75	$10.72
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $21.31 / $27.54 / $38.19	Professional	TC	$21.31	$27.54	$38.19
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $3.66 / $4.08 / $4.08	Facility	26	$3.66	$4.08	$4.08
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $21.17 / $33.47 / $43.75	Professional		$21.17	$33.47	$43.75
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $3.84 / $6.09 / $8.63	Professional	26	$3.84	$6.09	$8.63
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $17.38 / $27.39 / $35.22	Professional	TC	$17.38	$27.39	$35.22
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $107.98 / $107.98 / $354.01	Facility	26	$107.98	$107.98	$354.01
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $20.79 / $29.27 / $43.16	Professional		$20.79	$29.27	$43.16
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $3.98 / $5.30 / $8.91	Professional	26	$3.98	$5.30	$8.91
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $16.63 / $23.84 / $34.45	Professional	TC	$16.63	$23.84	$34.45
United Facility/Professional Professional Modifier Low / Median / High Price $20.67 / $33.00 / $54.61	Professional		$20.67	$33.00	$54.61
United Facility/Professional Professional Modifier 26 Low / Median / High Price $4.32 / $7.28 / $11.26	Professional	26	$4.32	$7.28	$11.26
United Facility/Professional Professional Modifier TC Low / Median / High Price $16.95 / $26.51 / $46.35	Professional	TC	$16.95	$26.51	$46.35
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $12.43 / $17.23 / $17.23	Professional		$12.43	$17.23	$17.23
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $2.21 / $2.75 / $2.75	Professional	26	$2.21	$2.75	$2.75
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $10.22 / $14.48 / $14.48	Professional	TC	$10.22	$14.48	$14.48