Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $15.21 / $17.55 / $32.97	Facility	26	$15.21	$17.55	$32.97
Aetna Facility/Professional Professional Modifier Low / Median / High Price $51.56 / $64.95 / $145.85	Professional		$51.56	$64.95	$145.85
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.24 / $15.21 / $51.09	Professional	26	$11.24	$15.21	$51.09
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $23.43 / $29.66 / $63.07	Professional	52	$23.43	$29.66	$63.07
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $39.22 / $48.17 / $100.57	Professional	TC	$39.22	$48.17	$100.57
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $81.55 / $104.86 / $120.69	Professional		$81.55	$104.86	$120.69
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $14.04 / $18.79 / $22.84	Professional	26	$14.04	$18.79	$22.84
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $23.85 / $80.00 / $85.00	Facility	26	$23.85	$80.00	$85.00
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $63.22 / $116.39 / $486.15	Professional		$63.22	$116.39	$486.15
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $14.33 / $25.56 / $96.53	Professional	26	$14.33	$25.56	$96.53
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $52.35 / $92.04 / $389.63	Professional	TC	$52.35	$92.04	$389.63
Cigna Facility/Professional Professional Modifier Low / Median / High Price $57.35 / $95.41 / $174.24	Professional		$57.35	$95.41	$174.24
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.59 / $20.87 / $35.53	Professional	26	$12.59	$20.87	$35.53
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $44.36 / $74.54 / $138.71	Professional	TC	$44.36	$74.54	$138.71
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $11.52 / $19.07 / $33.17	Facility	26	$11.52	$19.07	$33.17
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $50.88 / $84.46 / $144.81	Professional		$50.88	$84.46	$144.81
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $11.26 / $18.14 / $30.76	Professional	26	$11.26	$18.14	$30.76
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $39.76 / $65.50 / $114.19	Professional	TC	$39.76	$65.50	$114.19
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 $17.14 / $23.14 / $23.45	Facility	26	$17.14	$23.14	$23.45
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $14.07 / $19.23 / $24.67	Professional	26	$14.07	$19.23	$24.67
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $47.88 / $68.73 / $88.72	Professional	TC	$47.88	$68.73	$88.72
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $15.86 / $15.86 / $16.00	Facility	26	$15.86	$15.86	$16.00
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $77.28 / $123.27 / $152.38	Professional		$77.28	$123.27	$152.38
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $16.57 / $26.63 / $31.87	Professional	26	$16.57	$26.63	$31.87
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $60.78 / $96.63 / $120.64	Professional	TC	$60.78	$96.63	$120.64
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 $74.38 / $104.95 / $138.57	Professional		$74.38	$104.95	$138.57
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $16.17 / $22.75 / $29.87	Professional	26	$16.17	$22.75	$29.87
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $58.21 / $82.66 / $109.23	Professional	TC	$58.21	$82.66	$109.23
United Facility/Professional Professional Modifier Low / Median / High Price $57.23 / $86.08 / $149.50	Professional		$57.23	$86.08	$149.50
United Facility/Professional Professional Modifier 26 Low / Median / High Price $12.63 / $19.60 / $34.11	Professional	26	$12.63	$19.60	$34.11
United Facility/Professional Professional Modifier TC Low / Median / High Price $43.90 / $66.13 / $114.85	Professional	TC	$43.90	$66.13	$114.85
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $46.93 / $65.23 / $65.23	Professional		$46.93	$65.23	$65.23
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $9.66 / $12.20 / $12.20	Professional	26	$9.66	$12.20	$12.20
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $37.27 / $53.04 / $53.04	Professional	TC	$37.27	$53.04	$53.04