Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $18.30 / $29.60 / $40.68	Facility	26	$18.30	$29.60	$40.68
Aetna Facility/Professional Professional Modifier Low / Median / High Price $35.53 / $44.85 / $111.19	Professional		$35.53	$44.85	$111.19
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $13.12 / $15.81 / $38.58	Professional	26	$13.12	$15.81	$38.58
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $22.40 / $27.09 / $60.00	Professional	TC	$22.40	$27.09	$60.00
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $42.95 / $62.11 / $77.73	Professional		$42.95	$62.11	$77.73
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $13.39 / $27.44 / $27.44	Professional	26	$13.39	$27.44	$27.44
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $50.30 / $50.30 / $50.30	Professional	TC	$50.30	$50.30	$50.30
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $28.71 / $100.00 / $100.00	Facility	26	$28.71	$100.00	$100.00
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $44.04 / $80.95 / $348.00	Professional		$44.04	$80.95	$348.00
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $17.78 / $31.81 / $115.65	Professional	26	$17.78	$31.81	$115.65
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $29.00 / $54.78 / $219.53	Professional	TC	$29.00	$54.78	$219.53
Cigna Facility/Professional Professional Modifier Low / Median / High Price $39.96 / $67.23 / $120.94	Professional		$39.96	$67.23	$120.94
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $15.03 / $24.81 / $42.69	Professional	26	$15.03	$24.81	$42.69
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $24.93 / $42.42 / $78.25	Professional	TC	$24.93	$42.42	$78.25
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $13.64 / $22.05 / $39.45	Facility	26	$13.64	$22.05	$39.45
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $35.34 / $58.04 / $98.08	Professional		$35.34	$58.04	$98.08
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $13.02 / $21.00 / $34.67	Professional	26	$13.02	$21.00	$34.67
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $22.52 / $36.65 / $63.11	Professional	TC	$22.52	$36.65	$63.11
Molina Facility/Professional Professional Modifier Low / Median / High Price $9.59 / $53.61 / $98.32	Professional		$9.59	$53.61	$98.32
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $21.07 / $27.81 / $28.56	Facility	26	$21.07	$27.81	$28.56
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $16.88 / $23.92 / $28.98	Professional	26	$16.88	$23.92	$28.98
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $27.34 / $38.72 / $50.25	Professional	TC	$27.34	$38.72	$50.25
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $19.03 / $19.03 / $19.19	Facility	26	$19.03	$19.03	$19.19
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $54.99 / $86.74 / $106.13	Professional		$54.99	$86.74	$106.13
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $19.89 / $31.81 / $38.25	Professional	26	$19.89	$31.81	$38.25
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $34.58 / $54.78 / $68.03	Professional	TC	$34.58	$54.78	$68.03
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 $52.21 / $74.13 / $96.50	Professional		$52.21	$74.13	$96.50
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $19.39 / $27.30 / $35.83	Professional	26	$19.39	$27.30	$35.83
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $32.79 / $46.58 / $61.86	Professional	TC	$32.79	$46.58	$61.86
United Facility/Professional Professional Modifier Low / Median / High Price $38.36 / $58.30 / $108.30	Professional		$38.36	$58.30	$108.30
United Facility/Professional Professional Modifier 26 Low / Median / High Price $15.16 / $23.20 / $40.54	Professional	26	$15.16	$23.20	$40.54
United Facility/Professional Professional Modifier TC Low / Median / High Price $24.01 / $36.04 / $66.29	Professional	TC	$24.01	$36.04	$66.29
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $32.29 / $44.16 / $44.16	Professional		$32.29	$44.16	$44.16
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $11.60 / $14.68 / $14.68	Professional	26	$11.60	$14.68	$14.68
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $20.71 / $29.48 / $29.48	Professional	TC	$20.71	$29.48	$29.48