Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $8.73 / $10.63 / $22.14	Facility	26	$8.73	$10.63	$22.14
Aetna Facility/Professional Professional Modifier Low / Median / High Price $25.25 / $38.67 / $87.30	Professional		$25.25	$38.67	$87.30
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.03 / $8.73 / $22.14	Professional	26	$7.03	$8.73	$22.14
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $886.00 / $886.00 / $886.00	Professional	50	$886.00	$886.00	$886.00
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $11.04 / $17.25 / $34.79	Professional	52	$11.04	$17.25	$34.79
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $18.21 / $25.77 / $51.54	Professional	TC	$18.21	$25.77	$51.54
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $22.36 / $52.86 / $76.17	Professional		$22.36	$52.86	$76.17
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $5.99 / $12.86 / $13.48	Professional	26	$5.99	$12.86	$13.48
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $45.05 / $45.05 / $48.70	Professional	TC	$45.05	$45.05	$48.70
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 $39.72 / $69.45 / $248.78	Professional		$39.72	$69.45	$248.78
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $10.63 / $18.62 / $67.13	Professional	26	$10.63	$18.62	$67.13
Asuris Northwest Health Facility/Professional Professional Modifier 50 Low / Median / High Price $38.00 / $56.89 / $95.40	Professional	50	$38.00	$56.89	$95.40
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $29.11 / $49.68 / $184.65	Professional	TC	$29.11	$49.68	$184.65
Cigna Facility/Professional Professional Modifier Low / Median / High Price $27.00 / $50.73 / $92.67	Professional		$27.00	$50.73	$92.67
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.00 / $13.90 / $23.30	Professional	26	$8.00	$13.90	$23.30
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $19.01 / $35.90 / $69.94	Professional	TC	$19.01	$35.90	$69.94
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $8.97 / $17.43 / $236.39	Facility	26	$8.97	$17.43	$236.39
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $27.28 / $54.22 / $77.11	Professional		$27.28	$54.22	$77.11
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $8.25 / $16.68 / $21.43	Professional	26	$8.25	$16.68	$21.43
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $20.02 / $38.36 / $57.60	Professional	TC	$20.02	$38.36	$57.60
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 $11.76 / $15.11 / $15.41	Facility	26	$11.76	$15.11	$15.41
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $9.25 / $13.11 / $16.69	Professional	26	$9.25	$13.11	$16.69
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $22.26 / $32.33 / $41.61	Professional	TC	$22.26	$32.33	$41.61
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $10.42 / $10.42 / $10.51	Facility	26	$10.42	$10.42	$10.51
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $43.39 / $65.93 / $80.61	Professional		$43.39	$65.93	$80.61
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $11.86 / $17.80 / $21.56	Professional	26	$11.86	$17.80	$21.56
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $30.99 / $48.02 / $59.05	Professional	TC	$30.99	$48.02	$59.05
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $156.94 / $156.94 / $209.36	Facility	26	$156.94	$156.94	$209.36
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $40.18 / $58.91 / $77.56	Professional		$40.18	$58.91	$77.56
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $11.04 / $15.83 / $21.48	Professional	26	$11.04	$15.83	$21.48
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $29.11 / $43.16 / $58.84	Professional	TC	$29.11	$43.16	$58.84
United Facility/Professional Professional Modifier Low / Median / High Price $27.21 / $32.04 / $78.40	Professional		$27.21	$32.04	$78.40
United Facility/Professional Professional Modifier 26 Low / Median / High Price $7.88 / $9.13 / $21.84	Professional	26	$7.88	$9.13	$21.84
United Facility/Professional Professional Modifier TC Low / Median / High Price $20.21 / $23.48 / $55.34	Professional	TC	$20.21	$23.48	$55.34
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $32.39 / $32.39 / $32.39	Professional		$32.39	$32.39	$32.39
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $8.03 / $8.03 / $8.03	Professional	26	$8.03	$8.03	$8.03
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $24.35 / $24.35 / $24.35	Professional	TC	$24.35	$24.35	$24.35