Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $28.10 / $40.36 / $58.92	Facility	26	$28.10	$40.36	$58.92
Aetna Facility/Professional Professional Modifier Low / Median / High Price $39.60 / $63.37 / $113.33	Professional		$39.60	$63.37	$113.33
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $21.35 / $28.10 / $62.74	Professional	26	$21.35	$28.10	$62.74
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $18.23 / $37.86 / $66.39	Professional	TC	$18.23	$37.86	$66.39
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $88.37 / $88.37 / $103.83	Professional		$88.37	$88.37	$103.83
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $36.35 / $36.35 / $36.35	Professional	26	$36.35	$36.35	$36.35
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $65.81 / $65.81 / $65.81	Professional	TC	$65.81	$65.81	$65.81
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $41.16 / $80.00 / $97.62	Facility	26	$41.16	$80.00	$97.62
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $68.73 / $126.24 / $480.68	Professional		$68.73	$126.24	$480.68
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $27.42 / $45.80 / $165.08	Professional	26	$27.42	$45.80	$165.08
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $43.98 / $81.81 / $315.60	Professional	TC	$43.98	$81.81	$315.60
Cigna Facility/Professional Professional Modifier Low / Median / High Price $45.75 / $91.87 / $194.18	Professional		$45.75	$91.87	$194.18
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $22.90 / $38.26 / $66.55	Professional	26	$22.90	$38.26	$66.55
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $20.29 / $58.10 / $127.63	Professional	TC	$20.29	$58.10	$127.63
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $19.20 / $28.66 / $57.38	Facility	26	$19.20	$28.66	$57.38
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $34.56 / $53.69 / $103.18	Professional		$34.56	$53.69	$103.18
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $19.20 / $28.32 / $52.76	Professional	26	$19.20	$28.32	$52.76
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $15.36 / $25.00 / $49.15	Professional	TC	$15.36	$25.00	$49.15
Molina Facility/Professional Professional Modifier Low / Median / High Price $9.70 / $50.15 / $91.10	Professional		$9.70	$50.15	$91.10
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $32.34 / $39.81 / $41.48	Facility	26	$32.34	$39.81	$41.48
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $25.62 / $34.20 / $43.56	Professional	26	$25.62	$34.20	$43.56
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $19.35 / $28.80 / $66.95	Professional	TC	$19.35	$28.80	$66.95
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $27.42 / $27.63 / $27.63	Facility	26	$27.42	$27.63	$27.63
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $83.92 / $125.58 / $152.38	Professional		$83.92	$125.58	$152.38
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $30.83 / $44.90 / $54.43	Professional	26	$30.83	$44.90	$54.43
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $53.95 / $78.52 / $97.97	Professional	TC	$53.95	$78.52	$97.97
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $72.06 / $72.06 / $127.19	Facility	26	$72.06	$72.06	$127.19
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $68.73 / $100.34 / $140.27	Professional		$68.73	$100.34	$140.27
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $28.18 / $37.19 / $49.80	Professional	26	$28.18	$37.19	$49.80
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $44.33 / $64.95 / $89.08	Professional	TC	$44.33	$64.95	$89.08
United Facility/Professional Professional Modifier Low / Median / High Price $50.88 / $73.66 / $160.55	Professional		$50.88	$73.66	$160.55
United Facility/Professional Professional Modifier 26 Low / Median / High Price $24.00 / $34.84 / $59.39	Professional	26	$24.00	$34.84	$59.39
United Facility/Professional Professional Modifier TC Low / Median / High Price $22.45 / $42.86 / $103.56	Professional	TC	$22.45	$42.86	$103.56
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $45.83 / $62.81 / $62.81	Professional		$45.83	$62.81	$62.81
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $16.57 / $21.10 / $21.10	Professional	26	$16.57	$21.10	$21.10
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $29.27 / $41.71 / $41.71	Professional	TC	$29.27	$41.71	$41.71