Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $14.48 / $23.16 / $28.38	Facility	26	$14.48	$23.16	$28.38
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $36.82 / $83.55 / $644.62	Facility	TC	$36.82	$83.55	$644.62
Aetna Facility/Professional Professional Modifier Low / Median / High Price $35.22 / $45.22 / $101.15	Professional		$35.22	$45.22	$101.15
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.10 / $14.48 / $28.96	Professional	26	$11.10	$14.48	$28.96
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $23.17 / $31.64 / $61.61	Professional	TC	$23.17	$31.64	$61.61
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $70.31 / $70.31 / $70.31	Professional		$70.31	$70.31	$70.31
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $10.02 / $20.49 / $21.99	Professional	26	$10.02	$20.49	$21.99
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 $61.12 / $136.22 / $136.22	Facility	TC	$61.12	$136.22	$136.22
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $59.60 / $101.61 / $371.18	Professional		$59.60	$101.61	$371.18
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $17.55 / $30.15 / $105.00	Professional	26	$17.55	$30.15	$105.00
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $42.04 / $68.33 / $266.10	Professional	TC	$42.04	$68.33	$266.10
Cigna Facility/Professional Professional Modifier Low / Median / High Price $39.01 / $72.20 / $138.86	Professional		$39.01	$72.20	$138.86
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $13.82 / $23.62 / $38.63	Professional	26	$13.82	$23.62	$38.63
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $26.58 / $50.01 / $101.17	Professional	TC	$26.58	$50.01	$101.17
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $15.96 / $28.93 / $290.81	Facility	26	$15.96	$28.93	$290.81
Kaiser Permanente Facility/Professional Facility Modifier TC Low / Median / High Price $30.39 / $55.36 / $290.81	Facility	TC	$30.39	$55.36	$290.81
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $40.98 / $82.14 / $112.33	Professional		$40.98	$82.14	$112.33
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $14.35 / $28.80 / $35.15	Professional	26	$14.35	$28.80	$35.15
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $27.01 / $54.59 / $80.98	Professional	TC	$27.01	$54.59	$80.98
Molina Facility/Professional Professional Modifier Low / Median / High Price $9.15 / $54.51 / $92.81	Professional		$9.15	$54.51	$92.81
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $20.89 / $25.13 / $25.46	Facility	26	$20.89	$25.13	$25.46
Pacific Source Facility/Professional Facility Modifier TC Low / Median / High Price $49.49 / $59.23 / $60.97	Facility	TC	$49.49	$59.23	$60.97
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $15.28 / $20.90 / $25.46	Professional	26	$15.28	$20.90	$25.46
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $49.49 / $53.25 / $60.97	Professional	TC	$49.49	$53.25	$60.97
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $17.21 / $17.21 / $17.37	Facility	26	$17.21	$17.21	$17.37
Premera BCBS Facility/Professional Facility Modifier TC Low / Median / High Price $41.22 / $41.22 / $41.59	Facility	TC	$41.22	$41.22	$41.59
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $63.66 / $98.34 / $120.91	Professional		$63.66	$98.34	$120.91
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $19.62 / $29.41 / $35.61	Professional	26	$19.62	$29.41	$35.61
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $44.41 / $69.37 / $85.29	Professional	TC	$44.41	$69.37	$85.29
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 $59.60 / $88.37 / $116.35	Professional		$59.60	$88.37	$116.35
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $17.75 / $26.30 / $35.86	Professional	26	$17.75	$26.30	$35.86
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $42.04 / $62.34 / $84.98	Professional	TC	$42.04	$62.34	$84.98
United Facility/Professional Professional Modifier Low / Median / High Price $39.67 / $48.08 / $115.61	Professional		$39.67	$48.08	$115.61
United Facility/Professional Professional Modifier 26 Low / Median / High Price $13.71 / $15.58 / $37.54	Professional	26	$13.71	$15.58	$37.54
United Facility/Professional Professional Modifier TC Low / Median / High Price $25.60 / $33.90 / $82.95	Professional	TC	$25.60	$33.90	$82.95
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $48.73 / $48.73 / $48.73	Professional		$48.73	$48.73	$48.73
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $13.33 / $13.33 / $13.33	Professional	26	$13.33	$13.33	$13.33
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $35.40 / $35.40 / $35.40	Professional	TC	$35.40	$35.40	$35.40