Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $12.21 / $14.00 / $36.47	Facility	26	$12.21	$14.00	$36.47
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $43.20 / $176.73 / $739.80	Facility	TC	$43.20	$176.73	$739.80
Aetna Facility/Professional Professional Modifier Low / Median / High Price $33.18 / $57.88 / $183.11	Professional		$33.18	$57.88	$183.11
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.02 / $14.90 / $41.00	Professional	26	$10.02	$14.90	$41.00
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $72.23 / $124.11 / $414.00	Professional	50	$72.23	$124.11	$414.00
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $16.59 / $27.71 / $55.41	Professional	52	$16.59	$27.71	$55.41
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $27.87 / $43.70 / $87.76	Professional	TC	$27.87	$43.70	$87.76
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $63.96 / $79.59 / $121.85	Professional		$63.96	$79.59	$121.85
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $10.55 / $18.62 / $21.53	Professional	26	$10.55	$18.62	$21.53
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $31.44 / $62.20 / $79.37	Professional	TC	$31.44	$62.20	$79.37
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 / $165.02 / $165.02	Facility	TC	$100.00	$165.02	$165.02
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $56.62 / $110.82 / $410.25	Professional		$56.62	$110.82	$410.25
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $14.78 / $26.21 / $91.73	Professional	26	$14.78	$26.21	$91.73
Asuris Northwest Health Facility/Professional Professional Modifier 50 Low / Median / High Price $60.57 / $83.53 / $151.26	Professional	50	$60.57	$83.53	$151.26
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $47.69 / $82.68 / $318.52	Professional	TC	$47.69	$82.68	$318.52
Cigna Facility/Professional Professional Modifier Low / Median / High Price $41.84 / $77.65 / $154.16	Professional		$41.84	$77.65	$154.16
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.14 / $19.86 / $33.57	Professional	26	$11.14	$19.86	$33.57
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $30.81 / $57.31 / $119.27	Professional	TC	$30.81	$57.31	$119.27
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $10.85 / $23.98 / $290.81	Facility	26	$10.85	$23.98	$290.81
Kaiser Permanente Facility/Professional Facility Modifier TC Low / Median / High Price $31.00 / $61.98 / $290.81	Facility	TC	$31.00	$61.98	$290.81
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $41.85 / $83.14 / $124.31	Professional		$41.85	$83.14	$124.31
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $10.85 / $23.03 / $30.45	Professional	26	$10.85	$23.03	$30.45
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $30.76 / $59.16 / $97.78	Professional	TC	$30.76	$59.16	$97.78
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 $18.14 / $21.44 / $22.11	Facility	26	$18.14	$21.44	$22.11
Pacific Source Facility/Professional Facility Modifier TC Low / Median / High Price $44.10 / $60.97 / $73.03	Facility	TC	$44.10	$60.97	$73.03
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $51.85 / $51.85 / $51.85	Professional		$51.85	$51.85	$51.85
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $14.92 / $19.30 / $22.92	Professional	26	$14.92	$19.30	$22.92
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $37.52 / $50.92 / $63.92	Professional	TC	$37.52	$50.92	$63.92
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $14.50 / $14.50 / $15.08	Facility	26	$14.50	$14.50	$15.08
Premera BCBS Facility/Professional Facility Modifier TC Low / Median / High Price $48.02 / $48.02 / $49.81	Facility	TC	$48.02	$48.02	$49.81
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $68.87 / $106.53 / $133.10	Professional		$68.87	$106.53	$133.10
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $17.01 / $25.16 / $30.93	Professional	26	$17.01	$25.16	$30.93
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $53.82 / $83.09 / $102.17	Professional	TC	$53.82	$83.09	$102.17
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 / $96.31 / $127.54	Professional		$63.76	$96.31	$127.54
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $15.42 / $22.61 / $30.13	Professional	26	$15.42	$22.61	$30.13
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $48.97 / $73.58 / $99.82	Professional	TC	$48.97	$73.58	$99.82
United Facility/Professional Professional Modifier Low / Median / High Price $40.06 / $51.32 / $121.56	Professional		$40.06	$51.32	$121.56
United Facility/Professional Professional Modifier 26 Low / Median / High Price $11.26 / $12.71 / $31.34	Professional	26	$11.26	$12.71	$31.34
United Facility/Professional Professional Modifier TC Low / Median / High Price $29.11 / $39.88 / $108.55	Professional	TC	$29.11	$39.88	$108.55
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $54.54 / $54.54 / $54.54	Professional		$54.54	$54.54	$54.54
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $11.64 / $11.64 / $11.64	Professional	26	$11.64	$11.64	$11.64
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $42.90 / $42.90 / $42.90	Professional	TC	$42.90	$42.90	$42.90