Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $9.72 / $13.83 / $20.19	Facility	26	$9.72	$13.83	$20.19
Aetna Facility/Professional Professional Modifier Low / Median / High Price $28.12 / $39.40 / $139.19	Professional		$28.12	$39.40	$139.19
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.10 / $10.16 / $35.04	Professional	26	$7.10	$10.16	$35.04
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $20.51 / $29.68 / $53.72	Professional	TC	$20.51	$29.68	$53.72
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $39.40 / $46.56 / $70.94	Professional		$39.40	$46.56	$70.94
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $10.91 / $12.64 / $13.66	Professional	26	$10.91	$12.64	$13.66
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $32.90 / $32.99 / $38.70	Professional	TC	$32.90	$32.99	$38.70
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $19.32 / $103.69 / $103.69	Facility	26	$19.32	$103.69	$103.69
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $35.28 / $59.50 / $644.00	Professional		$35.28	$59.50	$644.00
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $10.14 / $17.95 / $228.88	Professional	26	$10.14	$17.95	$228.88
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $26.08 / $45.32 / $542.00	Professional	TC	$26.08	$45.32	$542.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $32.68 / $51.42 / $87.05	Professional		$32.68	$51.42	$87.05
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.61 / $13.29 / $23.01	Professional	26	$8.61	$13.29	$23.01
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $23.45 / $38.22 / $64.92	Professional	TC	$23.45	$38.22	$64.92
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $8.19 / $14.52 / $20.25	Facility	26	$8.19	$14.52	$20.25
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $27.30 / $53.12 / $81.13	Professional		$27.30	$53.12	$81.13
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $8.19 / $14.76 / $20.02	Professional	26	$8.19	$14.76	$20.02
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $20.14 / $38.19 / $60.93	Professional	TC	$20.14	$38.19	$60.93
Molina Facility/Professional Professional Modifier Low / Median / High Price $9.13 / $53.27 / $92.54	Professional		$9.13	$53.27	$92.54
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $11.13 / $13.78 / $14.28	Facility	26	$11.13	$13.78	$14.28
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $8.44 / $11.56 / $15.52	Professional	26	$8.44	$11.56	$15.52
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $22.51 / $32.10 / $42.90	Professional	TC	$22.51	$32.10	$42.90
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $9.51 / $9.51 / $9.60	Facility	26	$9.51	$9.51	$9.60
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $38.65 / $57.17 / $71.39	Professional		$38.65	$57.17	$71.39
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $10.83 / $15.98 / $19.68	Professional	26	$10.83	$15.98	$19.68
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $27.87 / $41.16 / $50.61	Professional	TC	$27.87	$41.16	$50.61
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $35.11 / $49.40 / $67.36	Professional		$35.11	$49.40	$67.36
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $9.69 / $13.80 / $18.60	Professional	26	$9.69	$13.80	$18.60
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $25.41 / $35.75 / $48.50	Professional	TC	$25.41	$35.75	$48.50
United Facility/Professional Professional Modifier Low / Median / High Price $30.00 / $48.71 / $75.34	Professional		$30.00	$48.71	$75.34
United Facility/Professional Professional Modifier 26 Low / Median / High Price $8.39 / $12.35 / $20.80	Professional	26	$8.39	$12.35	$20.80
United Facility/Professional Professional Modifier TC Low / Median / High Price $22.14 / $36.17 / $54.32	Professional	TC	$22.14	$36.17	$54.32
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $28.22 / $28.22 / $28.22	Professional		$28.22	$28.22	$28.22
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $7.31 / $7.31 / $7.31	Professional	26	$7.31	$7.31	$7.31
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $20.92 / $20.92 / $20.92	Professional	TC	$20.92	$20.92	$20.92