Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $15.21 / $20.55 / $33.85	Facility	26	$15.21	$20.55	$33.85
Aetna Facility/Professional Professional Modifier Low / Median / High Price $40.52 / $49.23 / $113.28	Professional		$40.52	$49.23	$113.28
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.93 / $13.17 / $28.16	Professional	26	$10.93	$13.17	$28.16
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $29.00 / $35.26 / $78.18	Professional	TC	$29.00	$35.26	$78.18
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $40.42 / $64.44 / $84.56	Professional		$40.42	$64.44	$84.56
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $11.16 / $18.27 / $22.94	Professional	26	$11.16	$18.27	$22.94
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $23.85 / $80.00 / $85.00	Facility	26	$23.85	$80.00	$85.00
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $53.57 / $93.15 / $385.95	Professional		$53.57	$93.15	$385.95
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $14.33 / $25.38 / $96.53	Professional	26	$14.33	$25.38	$96.53
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $38.22 / $68.51 / $289.43	Professional	TC	$38.22	$68.51	$289.43
Cigna Facility/Professional Professional Modifier Low / Median / High Price $45.75 / $75.93 / $138.88	Professional		$45.75	$75.93	$138.88
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.59 / $20.87 / $35.53	Professional	26	$12.59	$20.87	$35.53
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $33.03 / $55.24 / $103.37	Professional	TC	$33.03	$55.24	$103.37
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $11.52 / $19.07 / $33.17	Facility	26	$11.52	$19.07	$33.17
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $40.00 / $66.84 / $115.14	Professional		$40.00	$66.84	$115.14
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $11.26 / $18.14 / $30.76	Professional	26	$11.26	$18.14	$30.76
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $29.35 / $48.27 / $83.44	Professional	TC	$29.35	$48.27	$83.44
Molina Facility/Professional Professional Modifier Low / Median / High Price $9.48 / $53.61 / $98.32	Professional		$9.48	$53.61	$98.32
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $18.55 / $23.14 / $23.45	Facility	26	$18.55	$23.14	$23.45
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $15.39 / $19.25 / $25.08	Professional	26	$15.39	$19.25	$25.08
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $38.29 / $54.45 / $66.33	Professional	TC	$38.29	$54.45	$66.33
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $15.86 / $15.86 / $16.00	Facility	26	$15.86	$15.86	$16.00
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $61.92 / $98.92 / $121.55	Professional		$61.92	$98.92	$121.55
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $16.57 / $26.63 / $31.87	Professional	26	$16.57	$26.63	$31.87
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $45.24 / $72.29 / $89.80	Professional	TC	$45.24	$72.29	$89.80
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 $59.60 / $84.62 / $110.52	Professional		$59.60	$84.62	$110.52
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $16.17 / $22.75 / $29.87	Professional	26	$16.17	$22.75	$29.87
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $43.43 / $61.66 / $81.66	Professional	TC	$43.43	$61.66	$81.66
United Facility/Professional Professional Modifier Low / Median / High Price $45.85 / $67.56 / $121.77	Professional		$45.85	$67.56	$121.77
United Facility/Professional Professional Modifier 26 Low / Median / High Price $12.63 / $19.26 / $33.79	Professional	26	$12.63	$19.26	$33.79
United Facility/Professional Professional Modifier TC Low / Median / High Price $33.35 / $49.28 / $87.12	Professional	TC	$33.35	$49.28	$87.12
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $37.27 / $51.55 / $51.55	Professional		$37.27	$51.55	$51.55
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $9.66 / $12.20 / $12.20	Professional	26	$9.66	$12.20	$12.20
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $27.61 / $39.34 / $39.34	Professional	TC	$27.61	$39.34	$39.34