Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $13.02 / $14.33 / $34.86	Facility	26	$13.02	$14.33	$34.86
Aetna Facility/Professional Professional Modifier Low / Median / High Price $38.97 / $66.48 / $196.37	Professional		$38.97	$66.48	$196.37
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $9.78 / $15.35 / $51.00	Professional	26	$9.78	$15.35	$51.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $27.93 / $51.01 / $97.12	Professional	TC	$27.93	$51.01	$97.12
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $36.44 / $72.09 / $82.64	Professional		$36.44	$72.09	$82.64
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $12.03 / $17.70 / $19.66	Professional	26	$12.03	$17.70	$19.66
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $58.38 / $58.38 / $58.38	Professional	TC	$58.38	$58.38	$58.38
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $20.38 / $100.00 / $100.00	Facility	26	$20.38	$100.00	$100.00
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $51.11 / $85.70 / $632.00	Professional		$51.11	$85.70	$632.00
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $13.71 / $22.41 / $223.21	Professional	26	$13.71	$22.41	$223.21
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $39.27 / $70.84 / $259.02	Professional	TC	$39.27	$70.84	$259.02
Cigna Facility/Professional Professional Modifier Low / Median / High Price $49.55 / $82.07 / $136.21	Professional		$49.55	$82.07	$136.21
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.55 / $19.89 / $32.22	Professional	26	$11.55	$19.89	$32.22
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $38.72 / $62.64 / $104.14	Professional	TC	$38.72	$62.64	$104.14
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $12.09 / $20.00 / $34.59	Facility	26	$12.09	$20.00	$34.59
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $53.48 / $85.19 / $142.60	Professional		$53.48	$85.19	$142.60
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $11.47 / $18.84 / $31.18	Professional	26	$11.47	$18.84	$31.18
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $40.96 / $67.98 / $108.69	Professional	TC	$40.96	$67.98	$108.69
Molina Facility/Professional Professional Modifier Low / Median / High Price $9.48 / $53.61 / $98.32	Professional		$9.48	$53.61	$98.32
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $16.48 / $19.80 / $24.79	Facility	26	$16.48	$19.80	$24.79
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $14.80 / $21.83 / $28.21	Professional	26	$14.80	$21.83	$28.21
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $43.57 / $75.81 / $93.15	Professional	TC	$43.57	$75.81	$93.15
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $13.59 / $13.59 / $13.71	Facility	26	$13.59	$13.59	$13.71
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $55.04 / $87.50 / $113.59	Professional		$55.04	$87.50	$113.59
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $14.21 / $22.83 / $27.55	Professional	26	$14.21	$22.83	$27.55
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $40.83 / $64.68 / $87.45	Professional	TC	$40.83	$64.68	$87.45
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $513.03 / $513.03 / $838.61	Facility	26	$513.03	$513.03	$838.61
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $53.13 / $76.09 / $111.62	Professional		$53.13	$76.09	$111.62
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $13.86 / $19.51 / $26.43	Professional	26	$13.86	$19.51	$26.43
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $39.27 / $56.53 / $86.81	Professional	TC	$39.27	$56.53	$86.81
United Facility/Professional Professional Modifier Low / Median / High Price $54.53 / $84.80 / $143.28	Professional		$54.53	$84.80	$143.28
United Facility/Professional Professional Modifier 26 Low / Median / High Price $12.60 / $20.35 / $33.54	Professional	26	$12.60	$20.35	$33.54
United Facility/Professional Professional Modifier TC Low / Median / High Price $42.22 / $66.30 / $109.25	Professional	TC	$42.22	$66.30	$109.25
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $32.29 / $44.67 / $44.67	Professional		$32.29	$44.67	$44.67
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $8.27 / $10.46 / $10.46	Professional	26	$8.27	$10.46	$10.46
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $24.02 / $34.21 / $34.21	Professional	TC	$24.02	$34.21	$34.21