Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $14.48 / $15.96 / $35.71	Facility	26	$14.48	$15.96	$35.71
Aetna Facility/Professional Professional Modifier Low / Median / High Price $35.63 / $50.45 / $121.50	Professional		$35.63	$50.45	$121.50
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.50 / $15.78 / $36.00	Professional	26	$11.50	$15.78	$36.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $24.12 / $35.97 / $62.74	Professional	TC	$24.12	$35.97	$62.74
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $69.22 / $78.45 / $88.69	Professional		$69.22	$78.45	$88.69
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $12.16 / $20.49 / $24.66	Professional	26	$12.16	$20.49	$24.66
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $32.63 / $64.03 / $64.03	Professional	TC	$32.63	$64.03	$64.03
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $100.00 / $100.00 / $100.00	Facility	26	$100.00	$100.00	$100.00
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $57.08 / $100.75 / $365.33	Professional		$57.08	$100.75	$365.33
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $17.55 / $31.27 / $105.00	Professional	26	$17.55	$31.27	$105.00
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $40.65 / $69.95 / $260.33	Professional	TC	$40.65	$69.95	$260.33
Cigna Facility/Professional Professional Modifier Low / Median / High Price $38.85 / $72.69 / $136.63	Professional		$38.85	$72.69	$136.63
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $13.55 / $23.28 / $38.63	Professional	26	$13.55	$23.28	$38.63
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $25.99 / $48.59 / $97.34	Professional	TC	$25.99	$48.59	$97.34
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $12.71 / $28.78 / $290.81	Facility	26	$12.71	$28.78	$290.81
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $37.54 / $78.95 / $112.18	Professional		$37.54	$78.95	$112.18
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $12.71 / $27.41 / $35.07	Professional	26	$12.71	$27.41	$35.07
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $25.42 / $52.48 / $81.09	Professional	TC	$25.42	$52.48	$81.09
Molina Facility/Professional Professional Modifier Low / Median / High Price $9.15 / $54.50 / $92.81	Professional		$9.15	$54.50	$92.81
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $20.89 / $25.13 / $25.84	Facility	26	$20.89	$25.13	$25.84
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $15.68 / $22.40 / $29.25	Professional	26	$15.68	$22.40	$29.25
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $30.08 / $43.32 / $53.13	Professional	TC	$30.08	$43.32	$53.13
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $17.21 / $17.21 / $17.37	Facility	26	$17.21	$17.21	$17.37
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $64.22 / $96.81 / $119.04	Professional		$64.22	$96.81	$119.04
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $19.59 / $29.41 / $36.17	Professional	26	$19.59	$29.41	$36.17
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $44.22 / $67.84 / $83.42	Professional	TC	$44.22	$67.84	$83.42
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $211.40 / $211.40 / $385.75	Facility	26	$211.40	$211.40	$385.75
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $58.21 / $87.00 / $114.07	Professional		$58.21	$87.00	$114.07
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $18.23 / $26.27 / $35.86	Professional	26	$18.23	$26.27	$35.86
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $40.65 / $60.97 / $82.87	Professional	TC	$40.65	$60.97	$82.87
United Facility/Professional Professional Modifier Low / Median / High Price $38.95 / $47.34 / $115.79	Professional		$38.95	$47.34	$115.79
United Facility/Professional Professional Modifier 26 Low / Median / High Price $13.36 / $15.60 / $40.06	Professional	26	$13.36	$15.60	$40.06
United Facility/Professional Professional Modifier TC Low / Median / High Price $25.61 / $33.17 / $77.09	Professional	TC	$25.61	$33.17	$77.09
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $47.94 / $47.94 / $47.94	Professional		$47.94	$47.94	$47.94
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $13.33 / $13.33 / $13.33	Professional	26	$13.33	$13.33	$13.33
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $34.61 / $34.61 / $34.61	Professional	TC	$34.61	$34.61	$34.61