Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $14.91 / $24.28 / $43.13	Facility	26	$14.91	$24.28	$43.13
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $35.96 / $73.38 / $291.61	Facility	TC	$35.96	$73.38	$291.61
Aetna Facility/Professional Professional Modifier Low / Median / High Price $35.39 / $44.51 / $85.17	Professional		$35.39	$44.51	$85.17
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.40 / $14.49 / $27.30	Professional	26	$11.40	$14.49	$27.30
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $22.85 / $29.86 / $57.87	Professional	TC	$22.85	$29.86	$57.87
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $32.95 / $32.95 / $32.95	Professional		$32.95	$32.95	$32.95
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $21.04 / $21.04 / $21.04	Professional	26	$21.04	$21.04	$21.04
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $50.00 / $70.00 / $70.00	Facility	26	$50.00	$70.00	$70.00
Asuris Northwest Health Facility/Professional Facility Modifier TC Low / Median / High Price $59.09 / $131.69 / $131.69	Facility	TC	$59.09	$131.69	$131.69
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $58.04 / $100.53 / $365.33	Professional		$58.04	$100.53	$365.33
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $17.68 / $30.94 / $107.93	Professional	26	$17.68	$30.94	$107.93
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $40.65 / $67.75 / $257.39	Professional	TC	$40.65	$67.75	$257.39
Cigna Facility/Professional Professional Modifier Low / Median / High Price $39.02 / $72.31 / $136.63	Professional		$39.02	$72.31	$136.63
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $14.16 / $24.46 / $39.68	Professional	26	$14.16	$24.46	$39.68
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $25.70 / $49.09 / $97.83	Professional	TC	$25.70	$49.09	$97.83
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $16.38 / $29.64 / $236.39	Facility	26	$16.38	$29.64	$236.39
Kaiser Permanente Facility/Professional Facility Modifier TC Low / Median / High Price $30.01 / $54.59 / $236.39	Facility	TC	$30.01	$54.59	$236.39
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $40.86 / $82.14 / $111.84	Professional		$40.86	$82.14	$111.84
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $14.72 / $29.50 / $36.01	Professional	26	$14.72	$29.50	$36.01
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $26.63 / $53.83 / $78.76	Professional	TC	$26.63	$53.83	$78.76
Molina Facility/Professional Professional Modifier Low / Median / High Price $9.15 / $54.73 / $92.91	Professional		$9.15	$54.73	$92.91
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $21.44 / $25.79 / $26.13	Facility	26	$21.44	$25.79	$26.13
Pacific Source Facility/Professional Facility Modifier TC Low / Median / High Price $47.84 / $57.24 / $58.96	Facility	TC	$47.84	$57.24	$58.96
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $15.28 / $21.44 / $28.47	Professional	26	$15.28	$21.44	$28.47
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $46.43 / $57.24 / $61.49	Professional	TC	$46.43	$57.24	$61.49
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $17.21 / $17.21 / $17.82	Facility	26	$17.21	$17.21	$17.82
Premera BCBS Facility/Professional Facility Modifier TC Low / Median / High Price $39.86 / $39.86 / $40.22	Facility	TC	$39.86	$39.86	$40.22
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $64.22 / $97.33 / $119.04	Professional		$64.22	$97.33	$119.04
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $20.13 / $30.19 / $37.11	Professional	26	$20.13	$30.19	$37.11
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $43.29 / $67.08 / $82.48	Professional	TC	$43.29	$67.08	$82.48
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 Facility Modifier TC Low / Median / High Price $156.94 / $156.94 / $209.36	Facility	TC	$156.94	$156.94	$209.36
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $58.21 / $87.00 / $114.07	Professional		$58.21	$87.00	$114.07
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $18.22 / $26.72 / $36.79	Professional	26	$18.22	$26.72	$36.79
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $40.65 / $60.28 / $82.18	Professional	TC	$40.65	$60.28	$82.18
United Facility/Professional Professional Modifier Low / Median / High Price $39.67 / $48.40 / $114.63	Professional		$39.67	$48.40	$114.63
United Facility/Professional Professional Modifier 26 Low / Median / High Price $14.07 / $16.68 / $41.12	Professional	26	$14.07	$16.68	$41.12
United Facility/Professional Professional Modifier TC Low / Median / High Price $25.81 / $32.79 / $80.22	Professional	TC	$25.81	$32.79	$80.22
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $47.94 / $47.94 / $47.94	Professional		$47.94	$47.94	$47.94
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $13.73 / $13.73 / $13.73	Professional	26	$13.73	$13.73	$13.73
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $34.21 / $34.21 / $34.21	Professional	TC	$34.21	$34.21	$34.21