Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $9.93 / $12.00 / $25.09	Facility	26	$9.93	$12.00	$25.09
Aetna Facility/Professional Professional Modifier Low / Median / High Price $23.61 / $33.49 / $75.59	Professional		$23.61	$33.49	$75.59
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.83 / $9.94 / $21.80	Professional	26	$7.83	$9.94	$21.80
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $52.94 / $52.94 / $52.94	Professional	50	$52.94	$52.94	$52.94
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $15.22 / $22.05 / $44.97	Professional	TC	$15.22	$22.05	$44.97
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $19.00 / $39.42 / $39.42	Professional		$19.00	$39.42	$39.42
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $4.84 / $15.71 / $16.98	Professional	26	$4.84	$15.71	$16.98
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 $32.90 / $57.96 / $207.75	Professional		$32.90	$57.96	$207.75
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $12.01 / $20.42 / $84.21	Professional	26	$12.01	$20.42	$84.21
Asuris Northwest Health Facility/Professional Professional Modifier 50 Low / Median / High Price $31.32 / $48.38 / $96.04	Professional	50	$31.32	$48.38	$96.04
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $22.08 / $37.51 / $165.00	Professional	TC	$22.08	$37.51	$165.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $28.84 / $49.14 / $77.86	Professional		$28.84	$49.14	$77.86
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $9.05 / $15.75 / $26.41	Professional	26	$9.05	$15.75	$26.41
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $18.91 / $32.78 / $51.23	Professional	TC	$18.91	$32.78	$51.23
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $8.68 / $19.18 / $290.81	Facility	26	$8.68	$19.18	$290.81
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $30.38 / $57.88 / $76.87	Professional		$30.38	$57.88	$76.87
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $8.76 / $18.42 / $23.99	Professional	26	$8.76	$18.42	$23.99
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $21.59 / $40.11 / $54.59	Professional	TC	$21.59	$40.11	$54.59
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 $13.72 / $17.11 / $17.68	Facility	26	$13.72	$17.11	$17.68
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $11.26 / $15.96 / $19.42	Professional	26	$11.26	$15.96	$19.42
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $23.76 / $33.75 / $42.88	Professional	TC	$23.76	$33.75	$42.88
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 $36.65 / $55.73 / $67.58	Professional		$36.65	$55.73	$67.58
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $13.36 / $20.12 / $24.37	Professional	26	$13.36	$20.12	$24.37
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $23.26 / $35.39 / $43.79	Professional	TC	$23.26	$35.39	$43.79
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 $34.86 / $49.70 / $70.98	Professional		$34.86	$49.70	$70.98
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $12.48 / $17.88 / $24.28	Professional	26	$12.48	$17.88	$24.28
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $21.60 / $31.51 / $47.22	Professional	TC	$21.60	$31.51	$47.22
United Facility/Professional Professional Modifier Low / Median / High Price $27.77 / $32.78 / $74.83	Professional		$27.77	$32.78	$74.83
United Facility/Professional Professional Modifier 26 Low / Median / High Price $9.17 / $10.40 / $24.70	Professional	26	$9.17	$10.40	$24.70
United Facility/Professional Professional Modifier TC Low / Median / High Price $18.38 / $22.51 / $45.65	Professional	TC	$18.38	$22.51	$45.65
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $27.20 / $27.20 / $27.20	Professional		$27.20	$27.20	$27.20
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $9.17 / $9.17 / $9.17	Professional	26	$9.17	$9.17	$9.17
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $18.03 / $18.03 / $18.03	Professional	TC	$18.03	$18.03	$18.03