Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $16.80 / $26.39 / $44.31	Facility	26	$16.80	$26.39	$44.31
Aetna Facility/Professional Professional Modifier Low / Median / High Price $56.75 / $84.65 / $223.20	Professional		$56.75	$84.65	$223.20
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $13.95 / $17.43 / $55.71	Professional	26	$13.95	$17.43	$55.71
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $42.39 / $63.95 / $121.21	Professional	TC	$42.39	$63.95	$121.21
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $55.11 / $131.69 / $150.11	Professional		$55.11	$131.69	$150.11
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $23.44 / $24.17 / $29.14	Professional	26	$23.44	$24.17	$29.14
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $104.62 / $104.62 / $104.62	Professional	TC	$104.62	$104.62	$104.62
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 $95.38 / $163.31 / $610.04	Professional		$95.38	$163.31	$610.04
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $20.79 / $36.36 / $125.63	Professional	26	$20.79	$36.36	$125.63
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $76.23 / $125.68 / $484.43	Professional	TC	$76.23	$125.68	$484.43
Cigna Facility/Professional Professional Modifier Low / Median / High Price $63.98 / $115.15 / $229.35	Professional		$63.98	$115.15	$229.35
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $16.37 / $27.95 / $45.59	Professional	26	$16.37	$27.95	$45.59
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $48.47 / $88.26 / $184.84	Professional	TC	$48.47	$88.26	$184.84
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $15.19 / $34.11 / $290.81	Facility	26	$15.19	$34.11	$290.81
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $61.64 / $128.32 / $184.36	Professional		$61.64	$128.32	$184.36
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $15.19 / $32.39 / $41.16	Professional	26	$15.19	$32.39	$41.16
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $46.62 / $96.94 / $148.00	Professional	TC	$46.62	$96.94	$148.00
Molina Facility/Professional Professional Modifier Low / Median / High Price $18.70 / $107.33 / $184.15	Professional		$18.70	$107.33	$184.15
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $24.73 / $29.56 / $30.82	Facility	26	$24.73	$29.56	$30.82
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $18.48 / $24.73 / $33.47	Professional	26	$18.48	$24.73	$33.47
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $62.73 / $91.29 / $111.22	Professional	TC	$62.73	$91.29	$111.22
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $20.39 / $20.39 / $20.57	Facility	26	$20.39	$20.39	$20.57
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $106.70 / $160.85 / $197.77	Professional		$106.70	$160.85	$197.77
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $23.20 / $34.54 / $42.83	Professional	26	$23.20	$34.54	$42.83
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $83.95 / $126.54 / $155.59	Professional	TC	$83.95	$126.54	$155.59
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 $97.02 / $144.54 / $189.52	Professional		$97.02	$144.54	$189.52
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $21.60 / $31.14 / $42.31	Professional	26	$21.60	$31.14	$42.31
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $76.23 / $113.71 / $155.03	Professional	TC	$76.23	$113.71	$155.03
United Facility/Professional Professional Modifier Low / Median / High Price $63.12 / $78.65 / $187.77	Professional		$63.12	$78.65	$187.77
United Facility/Professional Professional Modifier 26 Low / Median / High Price $16.47 / $18.26 / $45.46	Professional	26	$16.47	$18.26	$45.46
United Facility/Professional Professional Modifier TC Low / Median / High Price $46.90 / $61.87 / $143.78	Professional	TC	$46.90	$61.87	$143.78
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $81.14 / $81.14 / $81.14	Professional		$81.14	$81.14	$81.14
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $15.75 / $15.75 / $15.75	Professional	26	$15.75	$15.75	$15.75
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $65.39 / $65.39 / $65.39	Professional	TC	$65.39	$65.39	$65.39