Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $12.16 / $17.07 / $29.12	Facility	26	$12.16	$17.07	$29.12
Aetna Facility/Professional Professional Modifier Low / Median / High Price $34.17 / $49.54 / $106.83	Professional		$34.17	$49.54	$106.83
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $9.41 / $12.16 / $27.74	Professional	26	$9.41	$12.16	$27.74
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $24.75 / $34.70 / $63.49	Professional	TC	$24.75	$34.70	$63.49
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $39.19 / $74.27 / $103.54	Professional		$39.19	$74.27	$103.54
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $8.88 / $17.23 / $20.70	Professional	26	$8.88	$17.23	$20.70
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $53.37 / $53.37 / $62.57	Professional	TC	$53.37	$53.37	$62.57
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 $53.00 / $93.61 / $343.05	Professional		$53.00	$93.61	$343.05
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $14.78 / $25.13 / $92.47	Professional	26	$14.78	$25.13	$92.47
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $39.27 / $67.80 / $254.48	Professional	TC	$39.27	$67.80	$254.48
Cigna Facility/Professional Professional Modifier Low / Median / High Price $36.79 / $69.02 / $128.35	Professional		$36.79	$69.02	$128.35
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.79 / $19.22 / $32.49	Professional	26	$10.79	$19.22	$32.49
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $25.91 / $48.53 / $96.08	Professional	TC	$25.91	$48.53	$96.08
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $12.71 / $23.72 / $290.81	Facility	26	$12.71	$23.72	$290.81
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $35.03 / $74.34 / $104.60	Professional		$35.03	$74.34	$104.60
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $11.41 / $22.74 / $29.15	Professional	26	$11.41	$22.74	$29.15
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $25.42 / $52.04 / $78.06	Professional	TC	$25.42	$52.04	$78.06
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 $17.59 / $20.89 / $21.76	Facility	26	$17.59	$20.89	$21.76
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $12.60 / $18.55 / $22.24	Professional	26	$12.60	$18.55	$22.24
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $30.55 / $43.32 / $54.94	Professional	TC	$30.55	$43.32	$54.94
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $14.50 / $14.50 / $14.62	Facility	26	$14.50	$14.50	$14.62
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $60.18 / $90.71 / $111.54	Professional		$60.18	$90.71	$111.54
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $16.44 / $24.77 / $29.99	Professional	26	$16.44	$24.77	$29.99
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $44.33 / $66.31 / $81.55	Professional	TC	$44.33	$66.31	$81.55
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 $54.05 / $81.52 / $106.89	Professional		$54.05	$81.52	$106.89
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $15.36 / $22.02 / $29.88	Professional	26	$15.36	$22.02	$29.88
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $39.27 / $59.32 / $80.04	Professional	TC	$39.27	$59.32	$80.04
United Facility/Professional Professional Modifier Low / Median / High Price $38.22 / $43.99 / $107.59	Professional		$38.22	$43.99	$107.59
United Facility/Professional Professional Modifier 26 Low / Median / High Price $11.10 / $13.30 / $33.72	Professional	26	$11.10	$13.30	$33.72
United Facility/Professional Professional Modifier TC Low / Median / High Price $27.07 / $32.07 / $87.27	Professional	TC	$27.07	$32.07	$87.27
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $45.01 / $45.01 / $45.01	Professional		$45.01	$45.01	$45.01
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $11.19 / $11.19 / $11.19	Professional	26	$11.19	$11.19	$11.19
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $33.82 / $33.82 / $33.82	Professional	TC	$33.82	$33.82	$33.82