Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $14.81 / $24.14 / $42.87	Facility	26	$14.81	$24.14	$42.87
Aetna Facility/Professional Professional Modifier Low / Median / High Price $34.85 / $54.19 / $110.61	Professional		$34.85	$54.19	$110.61
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.40 / $14.87 / $37.58	Professional	26	$12.40	$14.87	$37.58
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $18.36 / $27.10 / $54.19	Professional	52	$18.36	$27.10	$54.19
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $22.26 / $36.47 / $63.17	Professional	TC	$22.26	$36.47	$63.17
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $35.74 / $84.60 / $85.50	Professional		$35.74	$84.60	$85.50
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $20.94 / $21.86 / $22.54	Professional	26	$20.94	$21.86	$22.54
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $70.00 / $80.00 / $80.00	Facility	26	$70.00	$80.00	$80.00
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $56.52 / $106.87 / $393.00	Professional		$56.52	$106.87	$393.00
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $18.02 / $31.92 / $109.43	Professional	26	$18.02	$31.92	$109.43
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $43.18 / $73.42 / $283.58	Professional	TC	$43.18	$73.42	$283.58
Cigna Facility/Professional Professional Modifier Low / Median / High Price $40.79 / $74.39 / $146.49	Professional		$40.79	$74.39	$146.49
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $14.05 / $24.52 / $39.47	Professional	26	$14.05	$24.52	$39.47
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $25.68 / $51.00 / $106.11	Professional	TC	$25.68	$51.00	$106.11
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $13.33 / $29.56 / $290.81	Facility	26	$13.33	$29.56	$290.81
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $35.96 / $76.31 / $117.47	Professional		$35.96	$76.31	$117.47
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $13.45 / $28.82 / $36.10	Professional	26	$13.45	$28.82	$36.10
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $22.94 / $47.44 / $84.24	Professional	TC	$22.94	$47.44	$84.24
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 $21.43 / $25.55 / $27.47	Facility	26	$21.43	$25.55	$27.47
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $17.29 / $23.71 / $28.81	Professional	26	$17.29	$23.71	$28.81
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $27.36 / $38.40 / $51.10	Professional	TC	$27.36	$38.40	$51.10
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 $69.31 / $103.67 / $127.47	Professional		$69.31	$103.67	$127.47
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $20.10 / $30.61 / $37.11	Professional	26	$20.10	$30.61	$37.11
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $47.96 / $73.94 / $90.92	Professional	TC	$47.96	$73.94	$90.92
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 $62.37 / $93.16 / $122.16	Professional		$62.37	$93.16	$122.16
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 $44.35 / $64.16 / $89.65	Professional	TC	$44.35	$64.16	$89.65
United Facility/Professional Professional Modifier Low / Median / High Price $39.47 / $54.32 / $136.96	Professional		$39.47	$54.32	$136.96
United Facility/Professional Professional Modifier 26 Low / Median / High Price $14.07 / $17.93 / $39.58	Professional	26	$14.07	$17.93	$39.58
United Facility/Professional Professional Modifier TC Low / Median / High Price $25.49 / $39.11 / $91.20	Professional	TC	$25.49	$39.11	$91.20
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $51.82 / $51.82 / $51.82	Professional		$51.82	$51.82	$51.82
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $13.66 / $13.66 / $13.66	Professional	26	$13.66	$13.66	$13.66
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $38.15 / $38.15 / $38.15	Professional	TC	$38.15	$38.15	$38.15