Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $14.91 / $21.35 / $42.29	Facility	26	$14.91	$21.35	$42.29
Aetna Facility/Professional Professional Modifier Low / Median / High Price $47.71 / $73.09 / $169.20	Professional		$47.71	$73.09	$169.20
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.64 / $18.20 / $38.70	Professional	26	$12.64	$18.20	$38.70
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $33.61 / $48.72 / $79.84	Professional	TC	$33.61	$48.72	$79.84
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $42.25 / $101.09 / $140.09	Professional		$42.25	$101.09	$140.09
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $10.19 / $21.04 / $35.10	Professional	26	$10.19	$21.04	$35.10
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $64.94 / $76.41 / $89.58	Professional	TC	$64.94	$76.41	$89.58
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $100.00 / $110.00 / $110.00	Facility	26	$100.00	$110.00	$110.00
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $67.97 / $126.74 / $464.33	Professional		$67.97	$126.74	$464.33
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $18.02 / $31.57 / $113.92	Professional	26	$18.02	$31.57	$113.92
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $55.44 / $94.65 / $359.25	Professional	TC	$55.44	$94.65	$359.25
Cigna Facility/Professional Professional Modifier Low / Median / High Price $49.39 / $90.09 / $174.55	Professional		$49.39	$90.09	$174.55
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $14.92 / $25.73 / $38.63	Professional	26	$14.92	$25.73	$38.63
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $34.88 / $64.67 / $134.62	Professional	TC	$34.88	$64.67	$134.62
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $14.57 / $31.83 / $290.81	Facility	26	$14.57	$31.83	$290.81
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $45.99 / $96.72 / $142.50	Professional		$45.99	$96.72	$142.50
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $14.57 / $30.26 / $39.36	Professional	26	$14.57	$30.26	$39.36
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $31.31 / $64.28 / $108.49	Professional	TC	$31.31	$64.28	$108.49
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 $20.90 / $25.46 / $30.15	Facility	26	$20.90	$25.46	$30.15
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $18.48 / $27.04 / $31.63	Professional	26	$18.48	$27.04	$31.63
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $38.88 / $55.61 / $82.32	Professional	TC	$38.88	$55.61	$82.32
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $17.37 / $17.37 / $17.67	Facility	26	$17.37	$17.37	$17.67
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $81.42 / $122.73 / $150.91	Professional		$81.42	$122.73	$150.91
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $20.13 / $29.88 / $36.18	Professional	26	$20.13	$29.88	$36.18
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $59.40 / $93.76 / $115.29	Professional	TC	$59.40	$93.76	$115.29
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 $73.45 / $110.29 / $144.61	Professional		$73.45	$110.29	$144.61
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $18.72 / $26.30 / $39.01	Professional	26	$18.72	$26.30	$39.01
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $55.44 / $81.23 / $113.00	Professional	TC	$55.44	$81.23	$113.00
United Facility/Professional Professional Modifier Low / Median / High Price $51.25 / $57.10 / $139.88	Professional		$51.25	$57.10	$139.88
United Facility/Professional Professional Modifier 26 Low / Median / High Price $14.07 / $17.93 / $41.12	Professional	26	$14.07	$17.93	$41.12
United Facility/Professional Professional Modifier TC Low / Median / High Price $36.07 / $45.10 / $110.30	Professional	TC	$36.07	$45.10	$110.30
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $62.15 / $62.15 / $62.15	Professional		$62.15	$62.15	$62.15
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $13.73 / $13.73 / $13.73	Professional	26	$13.73	$13.73	$13.73
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $48.42 / $48.42 / $48.42	Professional	TC	$48.42	$48.42	$48.42