Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $9.08 / $14.96 / $30.30	Facility	26	$9.08	$14.96	$30.30
Aetna Facility/Professional Professional Modifier Low / Median / High Price $26.78 / $39.54 / $77.97	Professional		$26.78	$39.54	$77.97
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.00 / $9.09 / $17.85	Professional	26	$7.00	$9.09	$17.85
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $19.46 / $27.53 / $48.61	Professional	TC	$19.46	$27.53	$48.61
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $62.91 / $62.91 / $62.91	Professional		$62.91	$62.91	$62.91
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $13.45 / $13.45 / $14.47	Professional	26	$13.45	$13.45	$14.47
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $100.00 / $100.00 / $100.00	Facility	26	$100.00	$100.00	$100.00
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $45.28 / $79.01 / $289.27	Professional		$45.28	$79.01	$289.27
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $11.09 / $19.21 / $82.56	Professional	26	$11.09	$19.21	$82.56
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $33.57 / $57.74 / $222.45	Professional	TC	$33.57	$57.74	$222.45
Cigna Facility/Professional Professional Modifier Low / Median / High Price $29.91 / $55.37 / $108.13	Professional		$29.91	$55.37	$108.13
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.69 / $15.08 / $24.31	Professional	26	$8.69	$15.08	$24.31
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $21.87 / $39.96 / $83.08	Professional	TC	$21.87	$39.96	$83.08
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $9.77 / $18.19 / $290.81	Facility	26	$9.77	$18.19	$290.81
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $28.21 / $59.42 / $87.92	Professional		$28.21	$59.42	$87.92
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $9.00 / $18.19 / $22.29	Professional	26	$9.00	$18.19	$22.29
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $20.46 / $41.07 / $66.87	Professional	TC	$20.46	$41.07	$66.87
Molina Facility/Professional Professional Modifier Low / Median / High Price $9.15 / $54.50 / $92.81	Professional		$9.15	$54.50	$92.81
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $12.25 / $16.07 / $16.75	Facility	26	$12.25	$16.07	$16.75
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $10.50 / $14.50 / $18.00	Professional	26	$10.50	$14.50	$18.00
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $25.08 / $36.54 / $44.56	Professional	TC	$25.08	$36.54	$44.56
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $10.87 / $10.87 / $10.97	Facility	26	$10.87	$10.87	$10.97
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $48.70 / $76.23 / $93.73	Professional		$48.70	$76.23	$93.73
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $12.37 / $18.57 / $22.50	Professional	26	$12.37	$18.57	$22.50
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $36.89 / $57.93 / $71.23	Professional	TC	$36.89	$57.93	$71.23
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $211.40 / $211.40 / $385.75	Facility	26	$211.40	$211.40	$385.75
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $45.98 / $68.39 / $89.82	Professional		$45.98	$68.39	$89.82
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $11.52 / $16.61 / $22.99	Professional	26	$11.52	$16.61	$22.99
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $34.19 / $50.58 / $69.69	Professional	TC	$34.19	$50.58	$69.69
United Facility/Professional Professional Modifier Low / Median / High Price $30.60 / $36.90 / $88.94	Professional		$30.60	$36.90	$88.94
United Facility/Professional Professional Modifier 26 Low / Median / High Price $8.66 / $9.92 / $23.42	Professional	26	$8.66	$9.92	$23.42
United Facility/Professional Professional Modifier TC Low / Median / High Price $22.11 / $27.50 / $64.98	Professional	TC	$22.11	$27.50	$64.98
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $38.65 / $38.65 / $38.65	Professional		$38.65	$38.65	$38.65
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $8.77 / $8.77 / $8.77	Professional	26	$8.77	$8.77	$8.77
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $29.87 / $29.87 / $29.87	Professional	TC	$29.87	$29.87	$29.87