Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $12.16 / $18.54 / $26.04	Facility	26	$12.16	$18.54	$26.04
Aetna Facility/Professional Professional Modifier Low / Median / High Price $31.42 / $46.85 / $103.30	Professional		$31.42	$46.85	$103.30
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.22 / $12.16 / $28.94	Professional	26	$8.22	$12.16	$28.94
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $23.19 / $34.70 / $62.54	Professional	TC	$23.19	$34.70	$62.54
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $30.89 / $64.84 / $90.02	Professional		$30.89	$64.84	$90.02
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $8.35 / $18.46 / $28.75	Professional	26	$8.35	$18.46	$28.75
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $46.16 / $46.16 / $62.57	Professional	TC	$46.16	$46.16	$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 $51.94 / $93.82 / $340.13	Professional		$51.94	$93.82	$340.13
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $14.78 / $24.35 / $97.41	Professional	26	$14.78	$24.35	$97.41
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $39.27 / $67.48 / $251.55	Professional	TC	$39.27	$67.48	$251.55
Cigna Facility/Professional Professional Modifier Low / Median / High Price $35.40 / $64.81 / $127.24	Professional		$35.40	$64.81	$127.24
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $9.67 / $17.42 / $32.49	Professional	26	$9.67	$17.42	$32.49
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $25.33 / $46.86 / $95.60	Professional	TC	$25.33	$46.86	$95.60
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $11.07 / $20.66 / $290.81	Facility	26	$11.07	$20.66	$290.81
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $32.86 / $70.51 / $104.60	Professional		$32.86	$70.51	$104.60
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $10.01 / $19.76 / $27.20	Professional	26	$10.01	$19.76	$27.20
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $24.49 / $50.93 / $78.06	Professional	TC	$24.49	$50.93	$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 $15.39 / $20.59 / $21.76	Facility	26	$15.39	$20.59	$21.76
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $10.85 / $16.23 / $20.59	Professional	26	$10.85	$16.23	$20.59
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $29.35 / $43.50 / $50.19	Professional	TC	$29.35	$43.50	$50.19
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 $58.22 / $89.79 / $110.60	Professional		$58.22	$89.79	$110.60
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $16.19 / $24.77 / $29.99	Professional	26	$16.19	$24.77	$29.99
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $43.49 / $65.56 / $80.61	Professional	TC	$43.49	$65.56	$80.61
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 / $80.83 / $105.99	Professional		$54.05	$80.83	$105.99
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $14.78 / $21.99 / $29.88	Professional	26	$14.78	$21.99	$29.88
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $39.27 / $58.91 / $80.04	Professional	TC	$39.27	$58.91	$80.04
United Facility/Professional Professional Modifier Low / Median / High Price $35.40 / $43.99 / $105.75	Professional		$35.40	$43.99	$105.75
United Facility/Professional Professional Modifier 26 Low / Median / High Price $9.74 / $12.00 / $32.45	Professional	26	$9.74	$12.00	$32.45
United Facility/Professional Professional Modifier TC Low / Median / High Price $26.00 / $32.07 / $74.51	Professional	TC	$26.00	$32.07	$74.51
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