Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $4.20 / $6.01 / $8.77	Facility	26	$4.20	$6.01	$8.77
Aetna Facility/Professional Professional Modifier Low / Median / High Price $26.89 / $41.83 / $114.60	Professional		$26.89	$41.83	$114.60
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $3.14 / $4.46 / $15.00	Professional	26	$3.14	$4.46	$15.00
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $11.57 / $18.77 / $33.59	Professional	52	$11.57	$18.77	$33.59
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $23.61 / $35.28 / $82.00	Professional	TC	$23.61	$35.28	$82.00
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $36.43 / $43.61 / $49.69	Professional		$36.43	$43.61	$49.69
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $3.78 / $5.20 / $5.90	Professional	26	$3.78	$5.20	$5.90
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $36.61 / $36.72 / $43.07	Professional	TC	$36.61	$36.72	$43.07
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $39.94 / $101.15 / $101.15	Facility	26	$39.94	$101.15	$101.15
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $34.43 / $60.91 / $724.06	Professional		$34.43	$60.91	$724.06
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $4.32 / $7.85 / $289.41	Professional	26	$4.32	$7.85	$289.41
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $29.76 / $51.67 / $660.75	Professional	TC	$29.76	$51.67	$660.75
Cigna Facility/Professional Professional Modifier Low / Median / High Price $30.67 / $49.61 / $94.40	Professional		$30.67	$49.61	$94.40
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $3.76 / $5.95 / $9.99	Professional	26	$3.76	$5.95	$9.99
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $26.93 / $43.38 / $85.16	Professional	TC	$26.93	$43.38	$85.16
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $3.44 / $6.27 / $9.17	Facility	26	$3.44	$6.27	$9.17
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $25.73 / $53.65 / $111.93	Professional		$25.73	$53.65	$111.93
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $3.41 / $6.32 / $9.17	Professional	26	$3.41	$6.32	$9.17
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $21.86 / $47.12 / $103.13	Professional	TC	$21.86	$47.12	$103.13
Molina Facility/Professional Professional Modifier Low / Median / High Price $9.15 / $53.51 / $92.81	Professional		$9.15	$53.51	$92.81
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $4.95 / $6.01 / $6.70	Facility	26	$4.95	$6.01	$6.70
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $3.60 / $5.39 / $7.26	Professional	26	$3.60	$5.39	$7.26
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $24.81 / $37.17 / $67.00	Professional	TC	$24.81	$37.17	$67.00
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $4.08 / $4.08 / $4.11	Facility	26	$4.08	$4.08	$4.11
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $36.09 / $54.18 / $66.64	Professional		$36.09	$54.18	$66.64
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $4.62 / $6.86 / $8.44	Professional	26	$4.62	$6.86	$8.44
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $31.45 / $47.21 / $58.07	Professional	TC	$31.45	$47.21	$58.07
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $32.79 / $46.15 / $62.87	Professional		$32.79	$46.15	$62.87
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $4.16 / $5.92 / $7.97	Professional	26	$4.16	$5.92	$7.97
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $28.64 / $40.29 / $54.79	Professional	TC	$28.64	$40.29	$54.79
United Facility/Professional Professional Modifier Low / Median / High Price $27.30 / $49.35 / $80.39	Professional		$27.30	$49.35	$80.39
United Facility/Professional Professional Modifier 26 Low / Median / High Price $3.70 / $5.50 / $9.05	Professional	26	$3.70	$5.50	$9.05
United Facility/Professional Professional Modifier TC Low / Median / High Price $23.78 / $40.94 / $71.28	Professional	TC	$23.78	$40.94	$71.28
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $26.43 / $26.43 / $26.43	Professional		$26.43	$26.43	$26.43
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $3.15 / $3.15 / $3.15	Professional	26	$3.15	$3.15	$3.15
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $23.28 / $23.28 / $23.28	Professional	TC	$23.28	$23.28	$23.28