Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $14.10 / $23.02 / $45.79	Facility	26	$14.10	$23.02	$45.79
Aetna Facility/Professional Professional Modifier Low / Median / High Price $35.09 / $48.21 / $107.10	Professional		$35.09	$48.21	$107.10
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.07 / $14.11 / $34.46	Professional	26	$11.07	$14.11	$34.46
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $23.26 / $36.40 / $67.31	Professional	TC	$23.26	$36.40	$67.31
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $79.48 / $79.48 / $79.48	Professional		$79.48	$79.48	$79.48
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $6.84 / $19.95 / $21.43	Professional	26	$6.84	$19.95	$21.43
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $50.00 / $70.00 / $70.00	Facility	26	$50.00	$70.00	$70.00
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $58.50 / $100.25 / $368.48	Professional		$58.50	$100.25	$368.48
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $17.09 / $29.95 / $102.38	Professional	26	$17.09	$29.95	$102.38
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $41.58 / $67.98 / $266.10	Professional	TC	$41.58	$67.98	$266.10
Cigna Facility/Professional Professional Modifier Low / Median / High Price $38.86 / $70.87 / $137.90	Professional		$38.86	$70.87	$137.90
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $13.44 / $23.01 / $37.61	Professional	26	$13.44	$23.01	$37.61
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $26.58 / $48.32 / $101.17	Professional	TC	$26.58	$48.32	$101.17
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $12.40 / $28.04 / $236.39	Facility	26	$12.40	$28.04	$236.39
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $37.86 / $79.75 / $111.47	Professional		$37.86	$79.75	$111.47
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $12.40 / $26.75 / $34.15	Professional	26	$12.40	$26.75	$34.15
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $27.01 / $54.59 / $80.98	Professional	TC	$27.01	$54.59	$80.98
Molina Facility/Professional Professional Modifier Low / Median / High Price $9.15 / $54.73 / $92.91	Professional		$9.15	$54.73	$92.91
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $20.34 / $24.46 / $25.46	Facility	26	$20.34	$24.46	$25.46
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $15.28 / $20.35 / $26.22	Professional	26	$15.28	$20.35	$26.22
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $32.56 / $50.05 / $60.81	Professional	TC	$32.56	$50.05	$60.81
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $16.76 / $16.76 / $16.91	Facility	26	$16.76	$16.76	$16.91
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $65.98 / $97.57 / $119.97	Professional		$65.98	$97.57	$119.97
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $19.07 / $28.64 / $34.68	Professional	26	$19.07	$28.64	$34.68
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $46.02 / $69.37 / $85.29	Professional	TC	$46.02	$69.37	$85.29
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 $58.67 / $87.68 / $114.97	Professional		$58.67	$87.68	$114.97
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $17.76 / $25.60 / $34.95	Professional	26	$17.76	$25.60	$34.95
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $41.58 / $62.34 / $84.75	Professional	TC	$41.58	$62.34	$84.75
United Facility/Professional Professional Modifier Low / Median / High Price $39.17 / $46.54 / $121.61	Professional		$39.17	$46.54	$121.61
United Facility/Professional Professional Modifier 26 Low / Median / High Price $13.61 / $15.20 / $36.33	Professional	26	$13.61	$15.20	$36.33
United Facility/Professional Professional Modifier TC Low / Median / High Price $25.67 / $33.92 / $82.97	Professional	TC	$25.67	$33.92	$82.97
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $49.18 / $49.18 / $49.18	Professional		$49.18	$49.18	$49.18
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $12.99 / $12.99 / $12.99	Professional	26	$12.99	$12.99	$12.99
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $36.19 / $36.19 / $36.19	Professional	TC	$36.19	$36.19	$36.19