Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $43.94 / $201.00 / $517.57	Facility		$43.94	$201.00	$517.57
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $12.21 / $18.32 / $38.86	Facility	26	$12.21	$18.32	$38.86
Aetna Facility/Professional Professional Modifier Low / Median / High Price $29.19 / $43.93 / $96.02	Professional		$29.19	$43.93	$96.02
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $9.41 / $12.55 / $30.91	Professional	26	$9.41	$12.55	$30.91
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $19.76 / $31.72 / $58.71	Professional	TC	$19.76	$31.72	$58.71
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $28.82 / $68.48 / $68.48	Professional		$28.82	$68.48	$68.48
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $17.23 / $18.55 / $28.76	Professional	26	$17.23	$18.55	$28.76
Asuris Northwest Health Facility/Professional Facility Modifier Low / Median / High Price $112.24 / $277.93 / $342.77	Facility		$112.24	$277.93	$342.77
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 Professional Modifier Low / Median / High Price $50.00 / $88.06 / $317.10	Professional		$50.00	$88.06	$317.10
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $14.78 / $25.89 / $85.95	Professional	26	$14.78	$25.89	$85.95
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $36.04 / $61.34 / $231.23	Professional	TC	$36.04	$61.34	$231.23
Cigna Facility/Professional Facility Modifier Low / Median / High Price $127.23 / $297.08 / $374.65	Facility		$127.23	$297.08	$374.65
Cigna Facility/Professional Professional Modifier Low / Median / High Price $33.15 / $60.87 / $118.47	Professional		$33.15	$60.87	$118.47
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.14 / $19.52 / $31.47	Professional	26	$11.14	$19.52	$31.47
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $23.27 / $42.07 / $87.79	Professional	TC	$23.27	$42.07	$87.79
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $35.35 / $76.13 / $164.40	Facility		$35.35	$76.13	$164.40
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $13.05 / $23.98 / $236.39	Facility	26	$13.05	$23.98	$236.39
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $32.85 / $66.89 / $97.78	Professional		$32.85	$66.89	$97.78
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $11.78 / $22.74 / $30.01	Professional	26	$11.78	$22.74	$30.01
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $22.21 / $44.36 / $70.59	Professional	TC	$22.21	$44.36	$70.59
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 Low / Median / High Price $45.12 / $65.56 / $73.70	Facility		$45.12	$65.56	$73.70
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $15.68 / $20.77 / $21.44	Facility	26	$15.68	$20.77	$21.44
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $13.44 / $18.23 / $22.56	Professional	26	$13.44	$18.23	$22.56
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $27.34 / $36.78 / $45.22	Professional	TC	$27.34	$36.78	$45.22
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $49.83 / $49.83 / $50.27	Facility		$49.83	$49.83	$50.27
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $14.17 / $14.17 / $14.50	Facility	26	$14.17	$14.17	$14.50
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $55.63 / $83.98 / $103.10	Professional		$55.63	$83.98	$103.10
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $16.52 / $24.35 / $29.51	Professional	26	$16.52	$24.35	$29.51
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $38.86 / $60.22 / $74.05	Professional	TC	$38.86	$60.22	$74.05
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $156.94 / $251.08 / $489.71	Facility		$156.94	$251.08	$489.71
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 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 $15.36 / $21.45 / $29.43	Professional	26	$15.36	$21.45	$29.43
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $36.04 / $54.12 / $73.45	Professional	TC	$36.04	$54.12	$73.45
United Facility/Professional Professional Modifier Low / Median / High Price $33.34 / $43.51 / $101.19	Professional		$33.34	$43.51	$101.19
United Facility/Professional Professional Modifier 26 Low / Median / High Price $11.23 / $12.64 / $32.46	Professional	26	$11.23	$12.64	$32.46
United Facility/Professional Professional Modifier TC Low / Median / High Price $22.45 / $28.37 / $68.43	Professional	TC	$22.45	$28.37	$68.43
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $41.91 / $41.91 / $41.91	Professional		$41.91	$41.91	$41.91
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $11.25 / $11.25 / $11.25	Professional	26	$11.25	$11.25	$11.25
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $30.66 / $30.66 / $30.66	Professional	TC	$30.66	$30.66	$30.66