Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $15.27 / $24.91 / $60.57	Facility	26	$15.27	$24.91	$60.57
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $38.52 / $65.79 / $315.18	Facility	TC	$38.52	$65.79	$315.18
Aetna Facility/Professional Professional Modifier Low / Median / High Price $40.18 / $53.80 / $115.41	Professional		$40.18	$53.80	$115.41
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $13.25 / $16.16 / $42.64	Professional	26	$13.25	$16.16	$42.64
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $26.82 / $38.52 / $74.98	Professional	TC	$26.82	$38.52	$74.98
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $35.02 / $119.03 / $119.03	Professional		$35.02	$119.03	$119.03
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $21.58 / $21.58 / $21.58	Professional	26	$21.58	$21.58	$21.58
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 Facility Modifier TC Low / Median / High Price $100.00 / $142.32 / $142.32	Facility	TC	$100.00	$142.32	$142.32
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $61.24 / $108.31 / $385.43	Professional		$61.24	$108.31	$385.43
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $18.94 / $34.09 / $110.63	Professional	26	$18.94	$34.09	$110.63
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $43.43 / $75.23 / $296.00	Professional	TC	$43.43	$75.23	$296.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $46.73 / $82.50 / $144.27	Professional		$46.73	$82.50	$144.27
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $15.78 / $27.53 / $40.69	Professional	26	$15.78	$27.53	$40.69
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $30.42 / $55.69 / $104.52	Professional	TC	$30.42	$55.69	$104.52
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $16.43 / $34.29 / $290.81	Facility	26	$16.43	$34.29	$290.81
Kaiser Permanente Facility/Professional Facility Modifier TC Low / Median / High Price $29.45 / $61.85 / $290.81	Facility	TC	$29.45	$61.85	$290.81
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $44.74 / $96.01 / $127.37	Professional		$44.74	$96.01	$127.37
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $16.43 / $32.59 / $43.41	Professional	26	$16.43	$32.59	$43.41
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $29.14 / $61.22 / $85.65	Professional	TC	$29.14	$61.22	$85.65
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 $21.99 / $26.46 / $33.32	Facility	26	$21.99	$26.46	$33.32
Pacific Source Facility/Professional Facility Modifier TC Low / Median / High Price $45.03 / $56.89 / $62.98	Facility	TC	$45.03	$56.89	$62.98
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $20.00 / $26.80 / $34.00	Professional	26	$20.00	$26.80	$34.00
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $34.97 / $51.33 / $62.76	Professional	TC	$34.97	$51.33	$62.76
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $18.12 / $18.12 / $18.28	Facility	26	$18.12	$18.12	$18.28
Premera BCBS Facility/Professional Facility Modifier TC Low / Median / High Price $42.58 / $42.58 / $42.96	Facility	TC	$42.58	$42.58	$42.96
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $69.08 / $102.82 / $125.60	Professional		$69.08	$102.82	$125.60
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $20.65 / $31.40 / $37.49	Professional	26	$20.65	$31.40	$37.49
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $48.46 / $71.66 / $88.11	Professional	TC	$48.46	$71.66	$88.11
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 Facility Modifier TC Low / Median / High Price $211.40 / $211.40 / $385.75	Facility	TC	$211.40	$211.40	$385.75
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $61.91 / $91.79 / $120.86	Professional		$61.91	$91.79	$120.86
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $19.20 / $27.68 / $41.06	Professional	26	$19.20	$27.68	$41.06
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $43.43 / $64.39 / $87.79	Professional	TC	$43.43	$64.39	$87.79
United Facility/Professional Professional Modifier Low / Median / High Price $44.75 / $55.01 / $122.17	Professional		$44.75	$55.01	$122.17
United Facility/Professional Professional Modifier 26 Low / Median / High Price $14.80 / $18.73 / $38.42	Professional	26	$14.80	$18.73	$38.42
United Facility/Professional Professional Modifier TC Low / Median / High Price $29.95 / $35.04 / $82.01	Professional	TC	$29.95	$35.04	$82.01
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $51.04 / $51.04 / $51.04	Professional		$51.04	$51.04	$51.04
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $14.06 / $14.06 / $14.06	Professional	26	$14.06	$14.06	$14.06
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $36.97 / $36.97 / $36.97	Professional	TC	$36.97	$36.97	$36.97