Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $10.31 / $16.76 / $32.81	Facility	26	$10.31	$16.76	$32.81
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $28.32 / $67.73 / $283.50	Facility	TC	$28.32	$67.73	$283.50
Aetna Facility/Professional Professional Modifier Low / Median / High Price $26.78 / $38.64 / $81.90	Professional		$26.78	$38.64	$81.90
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.38 / $10.31 / $26.10	Professional	26	$8.38	$10.31	$26.10
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $18.32 / $26.57 / $54.75	Professional	TC	$18.32	$26.57	$54.75
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $6.75 / $14.10 / $24.23	Professional	26	$6.75	$14.10	$24.23
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 $50.00 / $110.49 / $110.49	Facility	TC	$50.00	$110.49	$110.49
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $44.81 / $77.36 / $286.13	Professional		$44.81	$77.36	$286.13
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $12.47 / $21.81 / $75.30	Professional	26	$12.47	$21.81	$75.30
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $32.34 / $54.14 / $210.83	Professional	TC	$32.34	$54.14	$210.83
Cigna Facility/Professional Professional Modifier Low / Median / High Price $30.20 / $54.74 / $106.85	Professional		$30.20	$54.74	$106.85
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $9.67 / $16.54 / $27.42	Professional	26	$9.67	$16.54	$27.42
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $21.03 / $38.21 / $79.98	Professional	TC	$21.03	$38.21	$79.98
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $11.07 / $20.46 / $236.39	Facility	26	$11.07	$20.46	$236.39
Kaiser Permanente Facility/Professional Facility Modifier TC Low / Median / High Price $21.72 / $43.83 / $236.39	Facility	TC	$21.72	$43.83	$236.39
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $29.72 / $62.35 / $86.60	Professional		$29.72	$62.35	$86.60
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $9.94 / $19.98 / $24.86	Professional	26	$9.94	$19.98	$24.86
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $20.65 / $43.06 / $64.64	Professional	TC	$20.65	$43.06	$64.64
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 $14.31 / $17.78 / $18.09	Facility	26	$14.31	$17.78	$18.09
Pacific Source Facility/Professional Facility Modifier TC Low / Median / High Price $32.49 / $44.11 / $48.24	Facility	TC	$32.49	$44.11	$48.24
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $11.34 / $14.85 / $19.04	Professional	26	$11.34	$14.85	$19.04
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $26.93 / $39.60 / $48.05	Professional	TC	$26.93	$39.60	$48.05
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $12.23 / $12.23 / $12.34	Facility	26	$12.23	$12.23	$12.34
Premera BCBS Facility/Professional Facility Modifier TC Low / Median / High Price $31.71 / $31.71 / $32.90	Facility	TC	$31.71	$31.71	$32.90
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $51.03 / $75.47 / $92.79	Professional		$51.03	$75.47	$92.79
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $13.92 / $20.90 / $25.31	Professional	26	$13.92	$20.90	$25.31
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $35.42 / $54.89 / $67.48	Professional	TC	$35.42	$54.89	$67.48
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 $46.25 / $67.70 / $88.92	Professional		$46.25	$67.70	$88.92
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $12.96 / $18.68 / $25.22	Professional	26	$12.96	$18.68	$25.22
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $32.39 / $48.85 / $65.92	Professional	TC	$32.39	$48.85	$65.92
United Facility/Professional Professional Modifier Low / Median / High Price $29.94 / $37.14 / $90.26	Professional		$29.94	$37.14	$90.26
United Facility/Professional Professional Modifier 26 Low / Median / High Price $9.67 / $11.26 / $27.39	Professional	26	$9.67	$11.26	$27.39
United Facility/Professional Professional Modifier TC Low / Median / High Price $20.54 / $26.84 / $65.64	Professional	TC	$20.54	$26.84	$65.64
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $38.19 / $38.19 / $38.19	Professional		$38.19	$38.19	$38.19
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $9.51 / $9.51 / $9.51	Professional	26	$9.51	$9.51	$9.51
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $28.69 / $28.69 / $28.69	Professional	TC	$28.69	$28.69	$28.69