Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $11.41 / $16.00 / $33.09	Facility	26	$11.41	$16.00	$33.09
Aetna Facility/Professional Professional Modifier Low / Median / High Price $32.92 / $46.57 / $93.71	Professional		$32.92	$46.57	$93.71
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.98 / $11.70 / $25.42	Professional	26	$8.98	$11.70	$25.42
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $21.79 / $30.02 / $56.43	Professional	TC	$21.79	$30.02	$56.43
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $64.03 / $64.03 / $64.72	Professional		$64.03	$64.03	$64.72
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $7.83 / $11.36 / $16.14	Professional	26	$7.83	$11.36	$16.14
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $39.71 / $39.71 / $49.64	Professional	TC	$39.71	$39.71	$49.64
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 $48.05 / $83.51 / $299.93	Professional		$48.05	$83.51	$299.93
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $13.86 / $24.27 / $92.47	Professional	26	$13.86	$24.27	$92.47
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $34.19 / $58.70 / $216.60	Professional	TC	$34.19	$58.70	$216.60
Cigna Facility/Professional Professional Modifier Low / Median / High Price $33.61 / $63.71 / $111.94	Professional		$33.61	$63.71	$111.94
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.00 / $19.14 / $30.46	Professional	26	$11.00	$19.14	$30.46
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $22.82 / $43.41 / $80.89	Professional	TC	$22.82	$43.41	$80.89
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $10.54 / $22.74 / $236.39	Facility	26	$10.54	$22.74	$236.39
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $34.40 / $71.27 / $95.05	Professional		$34.40	$71.27	$95.05
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $10.63 / $22.53 / $28.17	Professional	26	$10.63	$22.53	$28.17
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $24.18 / $48.62 / $67.45	Professional	TC	$24.18	$48.62	$67.45
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 $16.48 / $19.79 / $20.77	Facility	26	$16.48	$19.79	$20.77
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $13.20 / $18.09 / $23.38	Professional	26	$13.20	$18.09	$23.38
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $25.80 / $35.20 / $49.58	Professional	TC	$25.80	$35.20	$49.58
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $13.59 / $13.59 / $13.71	Facility	26	$13.59	$13.59	$13.71
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $53.61 / $79.28 / $97.48	Professional		$53.61	$79.28	$97.48
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $15.47 / $23.39 / $28.12	Professional	26	$15.47	$23.39	$28.12
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $38.01 / $56.31 / $69.36	Professional	TC	$38.01	$56.31	$69.36
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $156.94 / $156.94 / $209.36	Facility	26	$156.94	$156.94	$209.36
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $49.82 / $71.23 / $93.80	Professional		$49.82	$71.23	$93.80
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $14.40 / $20.76 / $29.43	Professional	26	$14.40	$20.76	$29.43
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $34.19 / $50.69 / $69.11	Professional	TC	$34.19	$50.69	$69.11
United Facility/Professional Professional Modifier Low / Median / High Price $34.65 / $41.54 / $98.79	Professional		$34.65	$41.54	$98.79
United Facility/Professional Professional Modifier 26 Low / Median / High Price $11.18 / $12.31 / $28.51	Professional	26	$11.18	$12.31	$28.51
United Facility/Professional Professional Modifier TC Low / Median / High Price $23.46 / $28.57 / $64.23	Professional	TC	$23.46	$28.57	$64.23
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $39.60 / $39.60 / $39.60	Professional		$39.60	$39.60	$39.60
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $10.52 / $10.52 / $10.52	Professional	26	$10.52	$10.52	$10.52
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $29.08 / $29.08 / $29.08	Professional	TC	$29.08	$29.08	$29.08