Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $7.19 / $9.52 / $17.84	Facility	26	$7.19	$9.52	$17.84
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $27.89 / $79.31 / $455.69	Facility	TC	$27.89	$79.31	$455.69
Aetna Facility/Professional Professional Modifier Low / Median / High Price $25.30 / $40.32 / $112.29	Professional		$25.30	$40.32	$112.29
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $5.53 / $7.69 / $19.47	Professional	26	$5.53	$7.69	$19.47
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $21.01 / $27.90 / $55.80	Professional	TC	$21.01	$27.90	$55.80
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $28.83 / $54.19 / $77.13	Professional		$28.83	$54.19	$77.13
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $5.11 / $10.19 / $12.36	Professional	26	$5.11	$10.19	$12.36
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $28.39 / $49.43 / $49.43	Professional	TC	$28.39	$49.43	$49.43
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 / $102.96 / $102.96	Facility	TC	$100.00	$102.96	$102.96
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $40.19 / $70.28 / $255.30	Professional		$40.19	$70.28	$255.30
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $8.77 / $14.92 / $54.49	Professional	26	$8.77	$14.92	$54.49
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $31.42 / $54.43 / $202.05	Professional	TC	$31.42	$54.43	$202.05
Cigna Facility/Professional Professional Modifier Low / Median / High Price $27.73 / $51.49 / $95.39	Professional		$27.73	$51.49	$95.39
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $6.60 / $11.46 / $19.21	Professional	26	$6.60	$11.46	$19.21
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $21.07 / $40.34 / $76.63	Professional	TC	$21.07	$40.34	$76.63
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $7.34 / $14.39 / $236.39	Facility	26	$7.34	$14.39	$236.39
Kaiser Permanente Facility/Professional Facility Modifier TC Low / Median / High Price $23.25 / $46.62 / $236.39	Facility	TC	$23.25	$46.62	$236.39
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $29.14 / $57.56 / $80.70	Professional		$29.14	$57.56	$80.70
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $6.75 / $13.64 / $17.14	Professional	26	$6.75	$13.64	$17.14
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $22.82 / $43.66 / $62.91	Professional	TC	$22.82	$43.66	$62.91
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 $9.31 / $12.44 / $12.73	Facility	26	$9.31	$12.44	$12.73
Pacific Source Facility/Professional Facility Modifier TC Low / Median / High Price $33.32 / $41.07 / $46.23	Facility	TC	$33.32	$41.07	$46.23
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $7.64 / $9.97 / $13.06	Professional	26	$7.64	$9.97	$13.06
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $25.71 / $34.17 / $46.75	Professional	TC	$25.71	$34.17	$46.75
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $8.61 / $8.61 / $8.68	Facility	26	$8.61	$8.61	$8.68
Premera BCBS Facility/Professional Facility Modifier TC Low / Median / High Price $30.80 / $30.80 / $31.53	Facility	TC	$30.80	$30.80	$31.53
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $43.29 / $67.08 / $82.48	Professional		$43.29	$67.08	$82.48
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $9.78 / $14.71 / $17.80	Professional	26	$9.78	$14.71	$17.80
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $33.94 / $52.50 / $64.67	Professional	TC	$33.94	$52.50	$64.67
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 $9.11 / $13.07 / $17.73	Professional	26	$9.11	$13.07	$17.73
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $31.42 / $47.27 / $64.04	Professional	TC	$31.42	$47.27	$64.04
United Facility/Professional Professional Modifier Low / Median / High Price $28.03 / $32.79 / $80.23	Professional		$28.03	$32.79	$80.23
United Facility/Professional Professional Modifier 26 Low / Median / High Price $6.49 / $7.55 / $18.05	Professional	26	$6.49	$7.55	$18.05
United Facility/Professional Professional Modifier TC Low / Median / High Price $21.22 / $26.12 / $62.90	Professional	TC	$21.22	$26.12	$62.90
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $33.35 / $33.35 / $33.35	Professional		$33.35	$33.35	$33.35
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $6.63 / $6.63 / $6.63	Professional	26	$6.63	$6.63	$6.63
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $26.72 / $26.72 / $26.72	Professional	TC	$26.72	$26.72	$26.72