Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $15.70 / $21.41 / $34.82	Facility	26	$15.70	$21.41	$34.82
Aetna Facility/Professional Professional Modifier Low / Median / High Price $36.61 / $47.73 / $83.89	Professional		$36.61	$47.73	$83.89
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.06 / $13.23 / $25.41	Professional	26	$11.06	$13.23	$25.41
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $24.99 / $33.29 / $60.72	Professional	TC	$24.99	$33.29	$60.72
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $41.11 / $41.11 / $41.11	Professional		$41.11	$41.11	$41.11
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $24.52 / $80.00 / $85.00	Facility	26	$24.52	$80.00	$85.00
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $53.00 / $89.79 / $383.03	Professional		$53.00	$89.79	$383.03
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $14.14 / $26.30 / $99.45	Professional	26	$14.14	$26.30	$99.45
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $34.61 / $62.96 / $283.58	Professional	TC	$34.61	$62.96	$283.58
Cigna Facility/Professional Professional Modifier Low / Median / High Price $43.95 / $72.08 / $137.85	Professional		$43.95	$72.08	$137.85
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.87 / $21.45 / $36.57	Professional	26	$12.87	$21.45	$36.57
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $30.63 / $50.79 / $101.28	Professional	TC	$30.63	$50.79	$101.28
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $11.78 / $19.30 / $34.07	Facility	26	$11.78	$19.30	$34.07
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $39.04 / $64.26 / $108.75	Professional		$39.04	$64.26	$108.75
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $11.26 / $18.64 / $31.44	Professional	26	$11.26	$18.64	$31.44
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $27.84 / $45.19 / $78.37	Professional	TC	$27.84	$45.19	$78.37
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 $17.64 / $23.80 / $24.12	Facility	26	$17.64	$23.80	$24.12
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $15.83 / $19.80 / $25.08	Professional	26	$15.83	$19.80	$25.08
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $35.11 / $50.92 / $63.85	Professional	TC	$35.11	$50.92	$63.85
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $16.30 / $16.30 / $16.45	Facility	26	$16.30	$16.30	$16.45
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $60.78 / $91.11 / $120.64	Professional		$60.78	$91.11	$120.64
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $17.05 / $27.39 / $32.79	Professional	26	$17.05	$27.39	$32.79
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $44.33 / $64.59 / $87.99	Professional	TC	$44.33	$64.59	$87.99
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $513.03 / $513.03 / $838.61	Facility	26	$513.03	$513.03	$838.61
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $54.05 / $78.48 / $104.83	Professional		$54.05	$78.48	$104.83
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $16.63 / $23.40 / $30.72	Professional	26	$16.63	$23.40	$30.72
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $37.42 / $54.55 / $75.08	Professional	TC	$37.42	$54.55	$75.08
United Facility/Professional Professional Modifier Low / Median / High Price $41.50 / $64.40 / $112.11	Professional		$41.50	$64.40	$112.11
United Facility/Professional Professional Modifier 26 Low / Median / High Price $13.23 / $19.80 / $34.76	Professional	26	$13.23	$19.80	$34.76
United Facility/Professional Professional Modifier TC Low / Median / High Price $30.02 / $45.76 / $78.06	Professional	TC	$30.02	$45.76	$78.06
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $36.72 / $50.76 / $50.76	Professional		$36.72	$50.76	$50.76
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $9.93 / $12.60 / $12.60	Professional	26	$9.93	$12.60	$12.60
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $26.78 / $38.15 / $38.15	Professional	TC	$26.78	$38.15	$38.15