Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $17.23 / $27.40 / $48.65	Facility	26	$17.23	$27.40	$48.65
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $37.25 / $79.23 / $311.79	Facility	TC	$37.25	$79.23	$311.79
Aetna Facility/Professional Professional Modifier Low / Median / High Price $37.95 / $47.29 / $93.48	Professional		$37.95	$47.29	$93.48
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $13.15 / $16.69 / $31.64	Professional	26	$13.15	$16.69	$31.64
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $23.51 / $31.93 / $61.84	Professional	TC	$23.51	$31.93	$61.84
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $35.79 / $35.79 / $35.79	Professional		$35.79	$35.79	$35.79
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 $63.14 / $140.77 / $140.77	Facility	TC	$63.14	$140.77	$140.77
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $62.54 / $109.46 / $393.45	Professional		$62.54	$109.46	$393.45
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $20.32 / $36.02 / $118.58	Professional	26	$20.32	$36.02	$118.58
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $42.96 / $70.97 / $274.88	Professional	TC	$42.96	$70.97	$274.88
Cigna Facility/Professional Professional Modifier Low / Median / High Price $41.88 / $77.56 / $147.13	Professional		$41.88	$77.56	$147.13
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $16.03 / $27.83 / $44.39	Professional	26	$16.03	$27.83	$44.39
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $27.45 / $50.71 / $104.52	Professional	TC	$27.45	$50.71	$104.52
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $18.48 / $34.04 / $290.81	Facility	26	$18.48	$34.04	$290.81
Kaiser Permanente Facility/Professional Facility Modifier TC Low / Median / High Price $30.76 / $56.43 / $290.81	Facility	TC	$30.76	$56.43	$290.81
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $44.43 / $88.06 / $121.76	Professional		$44.43	$88.06	$121.76
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $16.93 / $33.35 / $41.34	Professional	26	$16.93	$33.35	$41.34
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $27.38 / $55.34 / $84.71	Professional	TC	$27.38	$55.34	$84.71
Molina Facility/Professional Professional Modifier Low / Median / High Price $9.15 / $54.75 / $92.98	Professional		$9.15	$54.75	$92.98
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $23.65 / $28.81 / $30.82	Facility	26	$23.65	$28.81	$30.82
Pacific Source Facility/Professional Facility Modifier TC Low / Median / High Price $51.14 / $61.21 / $62.98	Facility	TC	$51.14	$61.21	$62.98
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $17.29 / $27.14 / $33.21	Professional	26	$17.29	$27.14	$33.21
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $33.75 / $61.21 / $62.98	Professional	TC	$33.75	$61.21	$62.98
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $19.64 / $19.64 / $19.93	Facility	26	$19.64	$19.64	$19.93
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 $69.28 / $105.77 / $128.41	Professional		$69.28	$105.77	$128.41
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $22.71 / $33.47 / $40.94	Professional	26	$22.71	$33.47	$40.94
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $46.73 / $72.29 / $88.11	Professional	TC	$46.73	$72.29	$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 $63.76 / $93.85 / $124.47	Professional		$63.76	$93.85	$124.47
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $20.32 / $29.76 / $42.31	Professional	26	$20.32	$29.76	$42.31
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $43.43 / $64.39 / $88.21	Professional	TC	$43.43	$64.39	$88.21
United Facility/Professional Professional Modifier Low / Median / High Price $42.56 / $51.81 / $124.52	Professional		$42.56	$51.81	$124.52
United Facility/Professional Professional Modifier 26 Low / Median / High Price $16.13 / $18.39 / $41.80	Professional	26	$16.13	$18.39	$41.80
United Facility/Professional Professional Modifier TC Low / Median / High Price $25.97 / $35.04 / $82.28	Professional	TC	$25.97	$35.04	$82.28
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $52.05 / $52.05 / $52.05	Professional		$52.05	$52.05	$52.05
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $15.47 / $15.47 / $15.47	Professional	26	$15.47	$15.47	$15.47
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $36.58 / $36.58 / $36.58	Professional	TC	$36.58	$36.58	$36.58