Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $11.27 / $12.40 / $25.07	Facility	26	$11.27	$12.40	$25.07
Aetna Facility/Professional Professional Modifier Low / Median / High Price $52.67 / $66.65 / $150.87	Professional		$52.67	$66.65	$150.87
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.66 / $10.02 / $35.03	Professional	26	$7.66	$10.02	$35.03
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $24.34 / $30.61 / $65.56	Professional	52	$24.34	$30.61	$65.56
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $43.71 / $54.58 / $119.62	Professional	TC	$43.71	$54.58	$119.62
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $50.90 / $103.90 / $120.19	Professional		$50.90	$103.90	$120.19
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $10.41 / $14.93 / $17.01	Professional	26	$10.41	$14.93	$17.01
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $95.38 / $95.38 / $95.38	Professional	TC	$95.38	$95.38	$95.38
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $17.60 / $80.00 / $80.00	Facility	26	$17.60	$80.00	$80.00
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $67.23 / $120.28 / $492.53	Professional		$67.23	$120.28	$492.53
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $10.61 / $18.64 / $72.15	Professional	26	$10.61	$18.64	$72.15
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $57.72 / $101.97 / $420.38	Professional	TC	$57.72	$101.97	$420.38
Cigna Facility/Professional Professional Modifier Low / Median / High Price $59.77 / $95.78 / $176.80	Professional		$59.77	$95.78	$176.80
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $9.19 / $15.27 / $26.34	Professional	26	$9.19	$15.27	$26.34
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $50.21 / $81.92 / $150.46	Professional	TC	$50.21	$81.92	$150.46
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $8.36 / $13.44 / $22.29	Facility	26	$8.36	$13.44	$22.29
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $52.08 / $84.96 / $148.34	Professional		$52.08	$84.96	$148.34
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $8.06 / $13.23 / $21.53	Professional	26	$8.06	$13.23	$21.53
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $44.24 / $71.95 / $126.82	Professional	TC	$44.24	$71.95	$126.82
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 $12.74 / $17.12 / $17.42	Facility	26	$12.74	$17.12	$17.42
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $11.43 / $15.08 / $19.82	Professional	26	$11.43	$15.08	$19.82
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $60.03 / $79.20 / $101.41	Professional	TC	$60.03	$79.20	$101.41
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $11.78 / $11.78 / $11.88	Facility	26	$11.78	$11.78	$11.88
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $79.48 / $128.59 / $154.21	Professional		$79.48	$128.59	$154.21
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $12.31 / $19.69 / $23.68	Professional	26	$12.31	$19.69	$23.68
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $66.64 / $108.81 / $130.62	Professional	TC	$66.64	$108.81	$130.62
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $79.93 / $110.51 / $143.04	Professional		$79.93	$110.51	$143.04
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $12.01 / $16.89 / $22.18	Professional	26	$12.01	$16.89	$22.18
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $67.91 / $93.65 / $121.54	Professional	TC	$67.91	$93.65	$121.54
United Facility/Professional Professional Modifier Low / Median / High Price $58.08 / $84.27 / $155.02	Professional		$58.08	$84.27	$155.02
United Facility/Professional Professional Modifier 26 Low / Median / High Price $9.17 / $14.04 / $25.34	Professional	26	$9.17	$14.04	$25.34
United Facility/Professional Professional Modifier TC Low / Median / High Price $48.88 / $74.48 / $135.85	Professional	TC	$48.88	$74.48	$135.85
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $46.38 / $64.97 / $64.97	Professional		$46.38	$64.97	$64.97
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $7.18 / $9.05 / $9.05	Professional	26	$7.18	$9.05	$9.05
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $39.20 / $55.92 / $55.92	Professional	TC	$39.20	$55.92	$55.92