Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $12.58 / $13.28 / $24.68	Facility	26	$12.58	$13.28	$24.68
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $31.71 / $108.56 / $544.30	Facility	TC	$31.71	$108.56	$544.30
Aetna Facility/Professional Professional Modifier Low / Median / High Price $30.19 / $44.30 / $106.20	Professional		$30.19	$44.30	$106.20
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.30 / $14.12 / $42.99	Professional	26	$10.30	$14.12	$42.99
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $19.89 / $30.45 / $55.29	Professional	TC	$19.89	$30.45	$55.29
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $60.95 / $69.70 / $98.05	Professional		$60.95	$69.70	$98.05
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $8.61 / $17.79 / $21.44	Professional	26	$8.61	$17.79	$21.44
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $48.40 / $48.40 / $48.40	Professional	TC	$48.40	$48.40	$48.40
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 $52.34 / $118.08 / $118.08	Facility	TC	$52.34	$118.08	$118.08
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $50.82 / $87.43 / $316.88	Professional		$50.82	$87.43	$316.88
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $15.25 / $26.40 / $88.58	Professional	26	$15.25	$26.40	$88.58
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $35.57 / $58.91 / $228.30	Professional	TC	$35.57	$58.91	$228.30
Cigna Facility/Professional Professional Modifier Low / Median / High Price $33.42 / $61.76 / $118.31	Professional		$33.42	$61.76	$118.31
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.84 / $20.14 / $32.49	Professional	26	$11.84	$20.14	$32.49
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $22.78 / $42.94 / $86.67	Professional	TC	$22.78	$42.94	$86.67
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $13.53 / $25.02 / $290.81	Facility	26	$13.53	$25.02	$290.81
Kaiser Permanente Facility/Professional Facility Modifier TC Low / Median / High Price $26.26 / $47.67 / $290.81	Facility	TC	$26.26	$47.67	$290.81
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $35.35 / $70.48 / $96.89	Professional		$35.35	$70.48	$96.89
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $12.15 / $24.42 / $30.87	Professional	26	$12.15	$24.42	$30.87
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $23.26 / $47.00 / $69.84	Professional	TC	$23.26	$47.00	$69.84
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 $17.60 / $21.44 / $22.11	Facility	26	$17.60	$21.44	$22.11
Pacific Source Facility/Professional Facility Modifier TC Low / Median / High Price $42.89 / $51.30 / $52.26	Facility	TC	$42.89	$51.30	$52.26
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $13.27 / $17.60 / $22.74	Professional	26	$13.27	$17.60	$22.74
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $34.32 / $43.28 / $52.26	Professional	TC	$34.32	$43.28	$52.26
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $14.62 / $14.62 / $14.95	Facility	26	$14.62	$14.62	$14.95
Premera BCBS Facility/Professional Facility Modifier TC Low / Median / High Price $34.88 / $34.88 / $35.65	Facility	TC	$34.88	$34.88	$35.65
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $55.63 / $84.77 / $103.10	Professional		$55.63	$84.77	$103.10
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $17.03 / $25.11 / $30.46	Professional	26	$17.03	$25.11	$30.46
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $38.36 / $59.46 / $73.11	Professional	TC	$38.36	$59.46	$73.11
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 $50.82 / $75.34 / $99.21	Professional		$50.82	$75.34	$99.21
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $15.25 / $22.14 / $30.35	Professional	26	$15.25	$22.14	$30.35
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $35.57 / $53.43 / $72.51	Professional	TC	$35.57	$53.43	$72.51
United Facility/Professional Professional Modifier Low / Median / High Price $33.90 / $41.47 / $105.44	Professional		$33.90	$41.47	$105.44
United Facility/Professional Professional Modifier 26 Low / Median / High Price $11.82 / $13.76 / $31.35	Professional	26	$11.82	$13.76	$31.35
United Facility/Professional Professional Modifier TC Low / Median / High Price $22.25 / $27.88 / $67.56	Professional	TC	$22.25	$27.88	$67.56
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $42.25 / $42.25 / $42.25	Professional		$42.25	$42.25	$42.25
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $11.59 / $11.59 / $11.59	Professional	26	$11.59	$11.59	$11.59
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $30.66 / $30.66 / $30.66	Professional	TC	$30.66	$30.66	$30.66