Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $18.67 / $30.40 / $55.71	Facility	26	$18.67	$30.40	$55.71
Aetna Facility/Professional Professional Modifier Low / Median / High Price $37.59 / $55.92 / $102.11	Professional		$37.59	$55.92	$102.11
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $14.08 / $18.67 / $39.01	Professional	26	$14.08	$18.67	$39.01
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $23.51 / $37.25 / $59.86	Professional	TC	$23.51	$37.25	$59.86
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $76.20 / $76.20 / $85.43	Professional		$76.20	$76.20	$85.43
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $25.57 / $28.40 / $31.84	Professional	26	$25.57	$28.40	$31.84
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $60.40 / $60.40 / $60.40	Professional	TC	$60.40	$60.40	$60.40
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $74.18 / $80.00 / $80.00	Facility	26	$74.18	$80.00	$80.00
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $64.44 / $111.86 / $405.83	Professional		$64.44	$111.86	$405.83
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $22.64 / $38.79 / $136.80	Professional	26	$22.64	$38.79	$136.80
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $42.04 / $72.76 / $269.02	Professional	TC	$42.04	$72.76	$269.02
Cigna Facility/Professional Professional Modifier Low / Median / High Price $42.04 / $79.92 / $150.94	Professional		$42.04	$79.92	$150.94
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $16.00 / $28.86 / $49.71	Professional	26	$16.00	$28.86	$49.71
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $25.14 / $50.00 / $100.63	Professional	TC	$25.14	$50.00	$100.63
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $15.33 / $34.24 / $290.81	Facility	26	$15.33	$34.24	$290.81
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $38.17 / $80.34 / $122.92	Professional		$38.17	$80.34	$122.92
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $15.33 / $32.60 / $43.93	Professional	26	$15.33	$32.60	$43.93
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $22.94 / $45.91 / $82.48	Professional	TC	$22.94	$45.91	$82.48
Molina Facility/Professional Professional Modifier Low / Median / High Price $9.20 / $54.50 / $92.81	Professional		$9.20	$54.50	$92.81
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $26.22 / $32.15 / $32.83	Facility	26	$26.22	$32.15	$32.83
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $19.70 / $27.98 / $34.29	Professional	26	$19.70	$27.98	$34.29
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $29.35 / $40.11 / $53.60	Professional	TC	$29.35	$40.11	$53.60
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $22.20 / $22.20 / $22.39	Facility	26	$22.20	$22.20	$22.39
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $72.69 / $107.53 / $132.16	Professional		$72.69	$107.53	$132.16
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $24.84 / $37.93 / $45.93	Professional	26	$24.84	$37.93	$45.93
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $47.43 / $70.13 / $86.23	Professional	TC	$47.43	$70.13	$86.23
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 $64.68 / $96.57 / $126.65	Professional		$64.68	$96.57	$126.65
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $23.52 / $33.71 / $45.76	Professional	26	$23.52	$33.71	$45.76
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $42.04 / $61.19 / $85.69	Professional	TC	$42.04	$61.19	$85.69
United Facility/Professional Professional Modifier Low / Median / High Price $42.56 / $58.89 / $133.94	Professional		$42.56	$58.89	$133.94
United Facility/Professional Professional Modifier 26 Low / Median / High Price $15.87 / $18.62 / $48.26	Professional	26	$15.87	$18.62	$48.26
United Facility/Professional Professional Modifier TC Low / Median / High Price $26.69 / $37.10 / $79.70	Professional	TC	$26.69	$37.10	$79.70
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $52.61 / $52.61 / $52.61	Professional		$52.61	$52.61	$52.61
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $17.21 / $17.21 / $17.21	Professional	26	$17.21	$17.21	$17.21
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $35.40 / $35.40 / $35.40	Professional	TC	$35.40	$35.40	$35.40