Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $10.63 / $12.33 / $35.15	Facility	26	$10.63	$12.33	$35.15
Aetna Facility/Professional Professional Modifier Low / Median / High Price $39.34 / $86.79 / $186.55	Professional		$39.34	$86.79	$186.55
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $9.22 / $10.92 / $27.24	Professional	26	$9.22	$10.92	$27.24
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $28.31 / $70.23 / $125.92	Professional	TC	$28.31	$70.23	$125.92
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $30.88 / $83.58 / $100.83	Professional		$30.88	$83.58	$100.83
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $7.44 / $15.06 / $16.89	Professional	26	$7.44	$15.06	$16.89
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $33.22 / $33.22 / $33.36	Professional	TC	$33.22	$33.22	$33.36
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $70.00 / $80.00 / $80.00	Facility	26	$70.00	$80.00	$80.00
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $50.82 / $94.62 / $539.95	Professional		$50.82	$94.62	$539.95
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $12.94 / $22.41 / $97.55	Professional	26	$12.94	$22.41	$97.55
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $40.67 / $76.45 / $492.53	Professional	TC	$40.67	$76.45	$492.53
Cigna Facility/Professional Professional Modifier Low / Median / High Price $45.70 / $84.66 / $137.79	Professional		$45.70	$84.66	$137.79
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.09 / $17.62 / $28.40	Professional	26	$10.09	$17.62	$28.40
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $34.11 / $67.59 / $113.71	Professional	TC	$34.11	$67.59	$113.71
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $11.76 / $21.22 / $290.81	Facility	26	$11.76	$21.22	$290.81
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $46.19 / $91.83 / $151.10	Professional		$46.19	$91.83	$151.10
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $10.67 / $21.07 / $25.72	Professional	26	$10.67	$21.07	$25.72
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $37.20 / $72.34 / $129.51	Professional	TC	$37.20	$72.34	$129.51
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 $15.39 / $18.46 / $19.43	Facility	26	$15.39	$18.46	$19.43
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $40.86 / $63.98 / $63.98	Professional		$40.86	$63.98	$63.98
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $12.32 / $17.39 / $21.42	Professional	26	$12.32	$17.39	$21.42
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $39.67 / $62.08 / $123.55	Professional	TC	$39.67	$62.08	$123.55
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $12.68 / $12.68 / $12.80	Facility	26	$12.68	$12.68	$12.80
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $59.17 / $89.80 / $111.38	Professional		$59.17	$89.80	$111.38
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $14.45 / $21.98 / $26.65	Professional	26	$14.45	$21.98	$26.65
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $45.01 / $67.84 / $84.73	Professional	TC	$45.01	$67.84	$84.73
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 $50.82 / $78.31 / $109.44	Professional		$50.82	$78.31	$109.44
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $13.44 / $19.38 / $26.67	Professional	26	$13.44	$19.38	$26.67
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $40.26 / $58.55 / $82.77	Professional	TC	$40.26	$58.55	$82.77
United Facility/Professional Professional Modifier Low / Median / High Price $29.24 / $68.09 / $115.65	Professional		$29.24	$68.09	$115.65
United Facility/Professional Professional Modifier 26 Low / Median / High Price $7.38 / $10.11 / $27.60	Professional	26	$7.38	$10.11	$27.60
United Facility/Professional Professional Modifier TC Low / Median / High Price $21.86 / $45.02 / $90.63	Professional	TC	$21.86	$45.02	$90.63
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $45.18 / $45.18 / $45.18	Professional		$45.18	$45.18	$45.18
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $9.78 / $9.78 / $9.78	Professional	26	$9.78	$9.78	$9.78
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $35.40 / $35.40 / $35.40	Professional	TC	$35.40	$35.40	$35.40