Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $14.91 / $24.42 / $49.62	Facility	26	$14.91	$24.42	$49.62
Aetna Facility/Professional Professional Modifier Low / Median / High Price $46.93 / $67.70 / $132.94	Professional		$46.93	$67.70	$132.94
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.41 / $14.91 / $30.76	Professional	26	$11.41	$14.91	$30.76
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $34.14 / $50.86 / $99.88	Professional	TC	$34.14	$50.86	$99.88
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $60.38 / $60.38 / $60.38	Professional		$60.38	$60.38	$60.38
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $7.52 / $12.73 / $21.47	Professional	26	$7.52	$12.73	$21.47
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 $81.31 / $140.21 / $519.60	Professional		$81.31	$140.21	$519.60
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $18.02 / $32.00 / $107.93	Professional	26	$18.02	$32.00	$107.93
Asuris Northwest Health Facility/Professional Professional Modifier 50 Low / Median / High Price $82.43 / $88.84 / $120.18	Professional	50	$82.43	$88.84	$120.18
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $63.29 / $103.68 / $411.68	Professional	TC	$63.29	$103.68	$411.68
Cigna Facility/Professional Professional Modifier Low / Median / High Price $53.68 / $95.35 / $195.75	Professional		$53.68	$95.35	$195.75
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $14.54 / $24.83 / $39.68	Professional	26	$14.54	$24.83	$39.68
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $40.49 / $74.14 / $154.35	Professional	TC	$40.49	$74.14	$154.35
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $13.45 / $29.64 / $290.81	Facility	26	$13.45	$29.64	$290.81
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $51.00 / $106.57 / $156.06	Professional		$51.00	$106.57	$156.06
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $13.45 / $28.87 / $36.28	Professional	26	$13.45	$28.87	$36.28
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $37.54 / $78.44 / $121.76	Professional	TC	$37.54	$78.44	$121.76
Molina Facility/Professional Professional Modifier Low / Median / High Price $15.02 / $73.02 / $159.79	Professional		$15.02	$73.02	$159.79
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $20.09 / $26.13 / $27.47	Facility	26	$20.09	$26.13	$27.47
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $16.48 / $24.60 / $27.71	Professional	26	$16.48	$24.60	$27.71
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $47.88 / $77.55 / $94.47	Professional	TC	$47.88	$77.55	$94.47
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $17.67 / $17.67 / $17.82	Facility	26	$17.67	$17.67	$17.82
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $91.03 / $137.21 / $168.71	Professional		$91.03	$137.21	$168.71
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $20.13 / $30.19 / $36.54	Professional	26	$20.13	$30.19	$36.54
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $68.37 / $107.48 / $132.16	Professional	TC	$68.37	$107.48	$132.16
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 $81.31 / $122.83 / $161.68	Professional		$81.31	$122.83	$161.68
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $18.72 / $26.99 / $37.71	Professional	26	$18.72	$26.99	$37.71
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $63.29 / $95.61 / $129.01	Professional	TC	$63.29	$95.61	$129.01
United Facility/Professional Professional Modifier Low / Median / High Price $52.30 / $66.34 / $162.28	Professional		$52.30	$66.34	$162.28
United Facility/Professional Professional Modifier 26 Low / Median / High Price $14.07 / $15.99 / $37.06	Professional	26	$14.07	$15.99	$37.06
United Facility/Professional Professional Modifier TC Low / Median / High Price $37.51 / $49.24 / $120.39	Professional	TC	$37.51	$49.24	$120.39
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $69.92 / $69.92 / $69.92	Professional		$69.92	$69.92	$69.92
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $14.00 / $14.00 / $14.00	Professional	26	$14.00	$14.00	$14.00
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $55.92 / $55.92 / $55.92	Professional	TC	$55.92	$55.92	$55.92