Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $9.15 / $14.98 / $29.11	Facility	26	$9.15	$14.98	$29.11
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $26.20 / $53.29 / $217.68	Facility	TC	$26.20	$53.29	$217.68
Aetna Facility/Professional Professional Modifier Low / Median / High Price $25.11 / $33.25 / $74.81	Professional		$25.11	$33.25	$74.81
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.00 / $8.91 / $19.43	Professional	26	$7.00	$8.91	$19.43
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $17.67 / $22.52 / $52.00	Professional	TC	$17.67	$22.52	$52.00
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $4.48 / $12.92 / $14.64	Professional	26	$4.48	$12.92	$14.64
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 / $98.42 / $98.42	Facility	TC	$50.00	$98.42	$98.42
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $40.19 / $69.31 / $254.55	Professional		$40.19	$69.31	$254.55
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $11.09 / $19.43 / $67.05	Professional	26	$11.09	$19.43	$67.05
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $29.11 / $49.31 / $187.50	Professional	TC	$29.11	$49.31	$187.50
Cigna Facility/Professional Professional Modifier Low / Median / High Price $27.71 / $50.41 / $94.90	Professional		$27.71	$50.41	$94.90
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.60 / $14.68 / $24.35	Professional	26	$8.60	$14.68	$24.35
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $19.48 / $35.60 / $71.06	Professional	TC	$19.48	$35.60	$71.06
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $9.84 / $18.19 / $236.39	Facility	26	$9.84	$18.19	$236.39
Kaiser Permanente Facility/Professional Facility Modifier TC Low / Median / High Price $20.25 / $41.52 / $236.39	Facility	TC	$20.25	$41.52	$236.39
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $27.53 / $55.63 / $78.59	Professional		$27.53	$55.63	$78.59
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $8.83 / $17.64 / $22.29	Professional	26	$8.83	$17.64	$22.29
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $19.71 / $39.86 / $57.21	Professional	TC	$19.71	$39.86	$57.21
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 $13.19 / $15.78 / $16.07	Facility	26	$13.19	$15.78	$16.07
Pacific Source Facility/Professional Facility Modifier TC Low / Median / High Price $31.35 / $39.24 / $42.88	Facility	TC	$31.35	$39.24	$42.88
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $9.65 / $13.20 / $17.88	Professional	26	$9.65	$13.20	$17.88
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $25.80 / $35.20 / $43.45	Professional	TC	$25.80	$35.20	$43.45
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $10.87 / $10.87 / $10.97	Facility	26	$10.87	$10.87	$10.97
Premera BCBS Facility/Professional Facility Modifier TC Low / Median / High Price $28.54 / $28.54 / $29.25	Facility	TC	$28.54	$28.54	$29.25
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $44.62 / $67.50 / $82.48	Professional		$44.62	$67.50	$82.48
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $12.37 / $18.57 / $22.84	Professional	26	$12.37	$18.57	$22.84
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $32.36 / $48.79 / $59.99	Professional	TC	$32.36	$48.79	$59.99
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 $41.34 / $60.28 / $79.04	Professional		$41.34	$60.28	$79.04
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $11.52 / $16.61 / $22.41	Professional	26	$11.52	$16.61	$22.41
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $29.11 / $43.84 / $59.33	Professional	TC	$29.11	$43.84	$59.33
United Facility/Professional Professional Modifier Low / Median / High Price $28.13 / $32.79 / $80.23	Professional		$28.13	$32.79	$80.23
United Facility/Professional Professional Modifier 26 Low / Median / High Price $8.60 / $10.00 / $22.79	Professional	26	$8.60	$10.00	$22.79
United Facility/Professional Professional Modifier TC Low / Median / High Price $19.47 / $23.86 / $57.31	Professional	TC	$19.47	$23.86	$57.31
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $33.97 / $33.97 / $33.97	Professional		$33.97	$33.97	$33.97
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $8.44 / $8.44 / $8.44	Professional	26	$8.44	$8.44	$8.44
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $25.53 / $25.53 / $25.53	Professional	TC	$25.53	$25.53	$25.53